What EMS Teams Need to Know to Improve LVO Stroke Outcomes

Montgomery County Hospital District (MCHD) EMS is just one of thousands of operations across the country working tirelessly to find the best solution to the issue coined the "pre-puncture problem." As alluded to by its name, this problem concerns determining the most effective course of action for getting large vessel occlusive (LVO) stroke patients to the best possible treatment center in the very limited time frame afforded to them.

Photo courtesy of Mongomery Country Hospital District EMS

MCHD personnel have recently chronicled their experiences and insights from managing this issue in an article published on EMS1 last week, titled "LVO stroke: How to improve EMS response and patient survival." 

MCHD uses the following criteria to first determine whether a patient is having a stroke, and if so, what the severity of their stroke is: 

Stroke identification - Signs and symptoms
To determine the presence of a stroke, pre-hospital providers look for one or more signs of a stroke:

• Sudden unilateral facial drooping/weakness.
• Sudden unilateral arm weakness.
• Sudden unilateral decreased grip strength.
• Sudden difficult speech/aphasia.

Stroke severity
If a patient has one or more stroke signs, a stable airway and blood glucose level of greater than 60 mg/dl, the stroke severity is assessed to decide if a patient should be transported to the closest designated primary stroke center or to a comprehensive stroke center.

A) Patient has one or more of the following:
1) GCS less than 9.
2) Asymmetric pupils.
3) Sudden severe headache w/no known cause.
4) Severe one-sided weakness or RACE ≥ 5.

AND

B) Diversion to comprehensive stroke center would NOT extend transport time by more than 15 minutes.

Citing just how crucial EMS is in the ultimate outcomes of stroke patients, the article states that "EMS is involved in approximately three-quarters of strokes treated in the U.S. and is associated with decreased onset-to-treatment times and improved clinical outcomes." The authors also emphasize the need for a reliable system in which EMS can notify the receiving hospital of their patient's status in order to allow that facility to activate a stroke response as early as possible. This early activation helps to reduce overall case times, ultimately leading to better patient outcomes. 

Pulsara's Stop Stroke platform is one such system that can help care teams decrease the time to treatment and ameliorate the pre-puncture problem. Studies using Pulsara have shown improvement in door-to-needle times of 28 to 46 percent, and 1.5 to 3.7 times improvement in the percentage of patients receiving therapy within the recommended 60 minutes or less [1-4].

See cases studies, demo videos and more about how Pulsara works right here.

---

References 

1. Dickson R, etal. Stop Stroke© A Novel Medical Application To Improve Coordination of Stroke Care: A Brief Report on Door to Thrombolysis Times After Initiating The Application. Stroke 2015;46:AWP207
2. Dickson RL Sumathipala D, Reeves, J. Stop Stroke© Acute Care Coordination Application : A Brief Report on Post-implementation Performance at a Primary Stroke Center. J Stroke and Cerebrovascular Disease.2016 Apr
3. Dickson RL, Seupaul R,  Neddelcut A, Stop STEMI- A Novel Medical Application to Improve The Coordination of STEMI Care: A Brief Report on Door-to-Balloon Times After Initiating the Application. Crit Pathways Cardiology: 2014(13)85-88
4. Antevy P MD, McTaggart R MD, Jayaaraman M MD. A Revolution in Stroke Care. http://www.emsworld.com/article/12061567/prehospital-stroke-care