EMS plays a critical role in identifying, treating, and directing stroke patients into a system of care. Time is brain for stroke patients, and as the first on-scene, your response time is critical to quickly identifying stroke symptoms, alerting the right care teams, and getting the patient the care they need. Every minute you can shave off their treatment time saves tissue and makes a big difference to the patient's quality of life. 

With those things in mind, here are 10 things you need to know about stroke:

What do EMS and hospital care teams have in common with NASCAR drivers?

Quite a bit, as it turns out. The success or failure of both hinges on one thing: time. 

It might surprise even dedicated fans to learn that all of the cars on the track are limited to the same top speed and horsepower range. With this being the case, how can it be that there is such a large disparity between first and last place?

The answer: The race is won and lost during the pit stop.

With Valentine’s Day just around the corner, hearts are everywhere—heart decorations, heart candies, heart cards, even heart pancakes for the more creative sweethearts. But one of the most important hearts of all too often gets overlooked: Your heart (or your heart health, to be specific)! 

February is American Heart Month: a national event to raise awareness about heart disease and what you can do to decrease your risks. Heart disease is the #1 cause of death for Americans, killing over 650,000 people annually. It is responsible for 1 in 4 deaths in the U.S. each year, and one person dies every 36 seconds from cardiovascular disease (that's heart disease and stroke combined). And that's not just for older adults; heart disease is becoming more and more common in young adults, making it important to learn whether you might be at risk.

Picture this:

About 12 hours into your 24-hour shift, you and your partner are finally sitting down to your first real meal of the day.

Just as the first bite of warm food hits your lips, the tones drop—an all-too-familiar scenario in the world of first responders. 

You’re dispatched to a 51-year-old male reporting chest pain. You walk in the door to a very distraught family, gathered around a man clutching his chest. He is pale and sweating profusely. You meet your partner’s eyes, and you know you’re both thinking the same thing. You quickly obtain the ECG and your suspicions are confirmed: tombstones in leads II, III, and AVF.

With state-of-the-art facilities and well-trained caregivers, St. Bernards’ cardiac teams were already achieving door-to-balloon (DTB) times well within the recommended guidelines for STEMI response. But that didn’t stop them from looking for ways to get even better.

“We have a lean process for STEMI response, but we needed a way to see the bigger picture for identifying areas we could improve,” said Lindsey Stacy, the hospital’s STEMI coordinator.

Longview Regional Medical Center (LRMC) has long had a well-designed and fully functioning process for identifying and rapidly treating STEMI patients. The hospital was meeting its goal of keeping door-to-reperfusion times under 60 minutes; as a result, patient outcomes were generally very good. Despite their satisfactory performance, the teams at LRMC believed they could reduce their treatment times even further to improve patient outcomes.

Since COVID-19 began spreading in the United States in March, emergency departments have seen a sharp decrease in the number of STEMI and stroke patients coming through their doors. For almost two months, polls and anecdotal evidence have suggested that this is happening all over the country, as well as in countries like Spain, the UK, and China. The Journal of the American College of Cardiology decided to conduct a formal study of nine major hospitals across the U.S. On April 7th, they released the results, confirming with statistical evidence what doctors have been experiencing: on average, the nine hospitals saw a 38% reduction in cath lab activations for STEMI patients.

Saint Mary’s Regional Health System is a Joint-Commission-accredited Level III Trauma Center, located in Russellville, Arkansas. The 170-bed hospital has delivered care to the River Valley community for the past 90 years, and alongside Pope County EMS since 1967.

Saint Mary’s and Pope County EMS have a long-standing relationship built on a shared value of putting patients first. As the only hospital and EMS agency serving their region, they together perform emergency response for 28,000 patients annually.

Because time is muscle during a STEMI, early intervention directly translates to lowering mortality and morbidity rates. At CarolinaEast and surrounding EMS agencies, making the appropriate communication changes has been an effective catalyst in reducing time to treatment and saving patients’ lives.

In emergency conditions like STEMI, patient outcomes depend heavily on the time between onset of symptoms to definitive treatment. As such, clinicians should make every effort possible to reduce any delays during that period. 

To that aim, an algorithm developed by the American Heart Association, and published earlier this week, establishes a standardized process which encourages pre-activation of the ED and determines when direct-to-cath-lab protocols are appropriate.

Pulsara is a communication platform that connects teams across organizations. Want to see how it works? While the demo video below focuses on a STEMI case started by EMS, STEMI is only one of the many conditions your teams can use Pulsara for. Additionally, care teams can start a case on Pulsara in the ED for walk in patients, from anywhere else in the facility for inpatients, and can use the platform to manage interfacility transfers.

When I was fresh out of Paramedic school, STEMI and stroke patients were something we couldn’t do much about except monitor and transport. To be honest, we hadn’t even started using the term "STEMI," and we were years away from giving aspirin. Patients who survived to get discharged out of the CCU or ICU (there were no stroke units then) went on to rehab or an extended care facility with a shoebox full of meds. They were armed with lots of Digitalis and Lasix, but not much hope.

“When I signed us up [for Pulsara], I had no idea I’d be one of the patients to use it.” -  El Dorado Fire Chief Mosby.

Picture this: You receive a 911 call for chest pain, and on arrival you are quick to identify that your patient is having a STEMI. You quickly load the patient into the medic unit and then notify the receiving facility you are on the way. You find out later that your patient went to the cath lab and is now in recovery doing well. Job well done….or was it?

Last February, the American Heart Association committed to saving 50,000 additional lives from in-hospital sudden cardiac arrest by 2025. In July, they announced RQI 2020 that offers a comprehensive end-to-end quality improvement program designed to deliver higher quality of CPR to health care systems.  The market debut will be January of 2019 through its newly formed joint venture with Laerdal, RQI Partners, LLC.

So what is RQI?

Resuscitation Quality Improvement, or RQI, is intended to improve Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) skills, while also making training more convenient for healthcare providers. Students can take the cognitive components of testing online and then test their psychomotor skills with real-time feedback by performing CPR at mobile Simulation Stations (such as SIM-MT, the state-wide simulation project based in Pulsara's home town of Bozeman, MT) equipped with adult and infant manikins.

According to a recent study published in JACC: Cardiovascular Interventions, activating the cath lab for patients with STEMI diagnosis before their arrival at the hospital led to significantly shorter wait times, shorter door-to-device times, and ultimately reduced mortality. 

A review of the study in MedPage Today stated: "Activating the cardiac catheterization laboratory at least 10 minutes before an ST-segment elevation MI (STEMI) patient arrived at the hospital was associated with less reperfusion delay -- and possibly better in-hospital survival, a large registry study showed.

Among patients with a pre-hospital diagnosis of STEMI who were transported by ambulance to a percutaneous coronary intervention (PCI) center, 41% had the cardiac cath lab activated more than 10 minutes before hospital arrival. Compared to cases with later cath lab activation, these patients were more likely to (P<0.001 for all):

• Be transported directly to the cath lab (23.3% versus 5.3%)
• Spend less time between hospital arrival and cath lab arrival (median 17 versus 28 min)
• Have shorter door-to-device time (40 versus 52 min)
• Achieve first medical contact-to-device times of 90 min or less (76.6% versus 68.6%)

Tomorrow at 8:00am PST, Pulsara's Founder and CEO, Dr. James Woodson, will be speaking at Take Heart America's State of the Future of Resuscitation Conference in Oakland, CA. The goal of the conference is to "discuss ways to combine the best evidence and experience from the innovative work of the participants to optimize the systems-of-care approach to cardiac arrest."

Dr. Woodson will present about the need for regional communication networks, and how they are critical to a systems of care approach to cardiac arrest.