EMS Stroke Resources & Training



Saving Lives: Understanding Strokes Web-Based Training for EMS



Advanced Stroke Life Support Courses (ASLS)

For more information about Advanced Stroke Life Support Courses, please see Continuing Education resource page and/or the ENCSN Stroke-Related Events Calendar.

EMS4stroke Modules

The management of a stroke patient begins in the ambulance before you reach the hospital. Find free, helpful EMS resources at the link below.

Link: http://www.strokeawareness.com/ems4stroke/

NC EMS Triage and Destination Plan Templates

Prehospital stroke screens

The NC Office of EMS recommends the use of the Cincinnati Prehospital Stroke Scale and the Los Angeles Prehospital Stroke Screening. The MENDS exam is taught during the ASLS training course.

CPSS, based on the National Institutes of Health (NIH) Stroke Scale, is a 3-item scale. Its purpose is to identify stroke patients who may be candidates for thrombolysis. LAPSS is one-page assessment tool to be used in the field to identify possible stroke patients. The MENDS exam is based on the NIH Stroke Scale and the Cincinnati Prehospital Stroke Scale and can be completed in less than 3 minutes. The MENDS can also be used as on-going neurological assessment for patients with focal deficits.



Nomenclature of stroke facilities

Brain Attack Coalition Definition of Comprehensive Stroke Center

  • An Acute Stroke Team with training and expertise in stroke must be available around-the-clock, seven days a week in order to evaluate within 15 minutes of arrival any patient who may have suffered a stroke.

  • A neurosurgeon must be available 24/7. The hospital should be able to provide Neurosurgical Services to stroke patients within two hours of when the services are deemed necessary.

  • The hospital must have written guidelines (care protocols) for emergency treatment of stroke patients. This standardizes, streamlines and accelerates the diagnosis and treatment of stroke patients, which is critical in minimizing complications.

  • The hospital should be well-known to area Emergency Medical Services (EMS) or rescue squads as the place to take suspected stroke victims. There should well-established and effective lines of communication between EMS and the stroke center during transport so that the proper diagnostic tests and treatment can begin as soon as possible upon the patient's arrival.

  • The hospital’s Emergency Department staff should be trained in diagnosing and treating stroke and have good lines of communication with both EMS and the acute stroke team.

  • The hospital must be capable of performing and evaluating a brain imaging (neuroimaging) study (such as a CT or MRI scan) within 45 minutes of the time it is ordered. And a specialist must be present at all hours who can interpret the findings. This is essential in making a fast, accurate diagnosis.

  • Laboratory services must be available around-the-clock

  • The hospital must have a dedicated neurological intensive care unit where patients with brain trauma can receive specialized monitoring and care beyond the initial life-threatening period.

Office of EMS Definition of Primary Stroke Center

  • "A hospital that is currently accredited by the Joint Commission as a Primary Stroke Center. Free standing emergency departments and satellite facilities are not considered part of the Primary Stroke Center."

Office of EMS Definition of Acute Stroke Capable Hospital

  • CT availability with in-house technician 24/7/365
  • Ability to rapidly evaluate an acute stroke patient to identify patients who would benefit from thrombolytic administration
  • Ability and willingness to administer thrombolytic agent to eligible acute stroke patients
  • Accepts all patients regardless of bed availability
  • Provides outcome and performance measure feedback to EMS including case review

Office of EMS Definition of Community Hospital

  • "A local hospital within the EMS System’s service area which provides emergency care but does not meet the criteria for a Primary Stroke Center or Stroke Capable Hospital."


Clarification from NC OEMS on “Stroke Capable Hospital” Designation

July 27, 2010. Download full pdf report here

5/5/11. EXCERPT: "...As our county EMS systems have adopted the triage and destination plans for stroke, there has been some misinterpretation as to whether a hospital providing services meeting the criteria under the definition of a “Stroke Capable Hospital” requires the OEMS to designate a hospital as such. This is not an accurate depiction of the function of our agency in relation to this definition.

Per North Carolina general statute and rule, the only hospitals the OEMS has authority to award any type of designation to, are to those who meet criteria for the management of trauma patients by the designation of trauma centers. All other designations awarded are unique to the respective accrediting bodies.

...The hospitals that meet the definition of a Primary Stroke Center are those that are certified by the Joint Commission as a Primary Stroke Center. Hospitals that are identified as either a Stroke Capable Hospital or a Community Hospital are those that the local EMS System have listed in their plan based on the terminology used in the Triage and Destination Templates. The definitions included in the Triage and Destination Templates are provided only as a guideline for EMS Systems in identifying a hospital’s capability and are not meant to signify that any hospital has been "designated" based on any specific accrediting standards defined by the Office of EMS."

Link: See past ENCSN presentation on the EMS Stroke Triage and Destination Plan.
(October 2009, ENCSN Quarterly Meeting).







Partnerships

Similar to the trauma (ERAC) and cardiac response (RACE) systems and initiatives in NC, it is the goal of ENCSN and partners such as the Office of Rural Health to have a coordinated and rapid prehospital response to stroke in eastern NC. Click the links below to learn more about RACE and ERAC.

  • ERAC (Eastern Regional Advisory Committee)
    • Created in 1998 to implement and coordinate a regional trauma system and improve trauma care in eastern North Carolina. There are representatives from 29 counties that make up the referral region for the Level 1 Trauma Center at Pitt County Memorial Hospital.


  • RACE (Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments (RACE)
    • A collaborative efforts between EMS personnel, physicians, nurses, administrators, and payers from five regions and 68 hospitals in North Carolina with the mission of increasing the rate and speed of coronary reperfusion through systemic changes in emergency care. As part of this initiative, average amount of time from door to treatment has been reduced.

  • Office of Minority Health (OMHHD)
    • Created in 1992, OMHHD mission is "to promote and advocate for the elimination of health disparities among all racial and ethnic minorities and other underserved populations in North Carolina."

EMS in the News

Please see the ENCSN News webpage to read about featured EMS stroke champions in eastern NC. Or visit the Duplin Times Newspaper (April 2010).

Celebrate National EMS Week is May 13-19, 2012.

For more information about Stroke/Hypertension awareness Month, please visit National EMS Week

Resources