EMS, Stroke Groups Publish Recommendations for Care Systems

PRESS RELEASE

Ensuring all people have access to timely, high-quality stroke care no matter where they live is an important goal of the American Stroke Association. 

The ASA is joined in this endeavor by the American Academy of Neurology, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, the Neurocritical Care Society, Society of NeuroInterventional Surgery, and Society of Vascular and Interventional Neurology. 

The organizations have endorsed consensus recommendations to support local and regional EMS agencies and stroke advisory committees in integrating the elements of a stroke system of care in three key regional settings: urban, suburban, and rural. When implemented, these recommendations can help ensure acute stroke patients are triaged to the right place in the right amount of time for the most appropriate treatment. 

A summary document distills three key takeaways:

1. The proven benefit of endovascular therapy (EVT) for patients with large vessel occlusion (LVO) has created the need for more specific guidance for updating regional stroke systems of care (SSOC) plans. The recommendations can help ensure acute stroke patients are triaged to the right place in the right amount of time for the most appropriate intervention, including intravenous thrombolysis and EVT. Selected patients with suspected stroke due to LVO should be preferentially triaged to the nearest EVT-capable stroke center.

2. With varying levels of stroke center certifications and unique regional and geographic considerations, local public health agencies are the organizations best suited to determine the most appropriate acute stroke destination plans that are simple, balanced, and actionable.

3. When a stroke facility with a lower certification level is closest, there is uncertainty concerning the acceptable additional transport time to a more comprehensive stroke facility. This paper provides local and regional emergency medical services agencies and stroke advisory committees with guiding principles and recommendations for how to integrate the elements of a stroke system of care in three key regional settings: urban, suburban and rural settings.

“With the advent of new treatments for stroke such as thrombectomy, the American Stroke Association recognized the need for a national consensus approach to acute stroke prehospital triage that considers differences in regional plans in urban, suburban, and rural environments,” says Lee H. Schwamm, MD, chair of the American Stroke Association Advisory Committee. “In time-critical conditions, the capabilities of the first destination hospital can strongly influence clinical outcomes, so it is vital to integrate both speed of transport with level of stroke care required for definitive treatment. This new statement, developed through consensus of leading professional organizations focused on stroke, provides needed recommendations to local communities and regions to improve their stroke systems of care.”

Find additional information and more about stroke transport for EMS from the ASA here.