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EMS RESOURCES ACUTE ISCHEMIC STROKE THERAPIES

BE PREPARED
TO TREAT STROKE

YOU PLAY A CRITICAL ROLE

It is critical for Emergency Medical Service (EMS) personnel to identify stroke symptoms and make the right transfer decisions to help ensure patients receive the treatment needed. This page will help you understand current Acute Ischemic Stroke (AIS) treatment options and the impact of the decisions you make when treating patients actively having a stroke.

STROKE IS AN EMERGENCY

Restricted blood flow to the brain results in neuron death (brain cells), therefore, it is critical that flow be restored as quickly as possible to minimize damage from ischemia.¹

As many as 1.9 million brain cells are lost every minute a stroke goes untreated.²

HOW IS STROKE TREATED?

MEDICAL MANAGEMENT WITH IV t-PA

This method uses a medication called t-PA (Recombinant Tissue Plasminogen Activator) to dissolve the clot and improve blood flow to the brain. It can be administered intravenously (IV). Some patients cannot receive this drug because of other medical conditions or medications they are taking and other patients may not arrive in time from their first primary symptom.³

MECHANICAL THROMBECTOMY WITH A STENT RETRIEVER

This method involves a minimally invasive surgical procedure that uses a tiny device called a stent retriever to remove blood clots in the brain, restoring blood flow. Since 2013, pivotal new evidence reported from eight randomized clinical trials⁴ justified changes in the American Heart Association/American Stroke Association (AHA/ASA) guidelines supporting this treatment for AIS patients meeting specific criteria. Learn more about stent retriever thrombectomy.

HOW SHOULD EMS RESPOND?

Fast response, achieved by proper stroke assessment and effective routing to the most comprehensive stroke center, can minimize the loss of brain function and reduce long-term disability.^3,5

1. IDENTIFY

Quickly recognize stroke symptoms. See FAST stroke signs.

2. EVALUATE

Use assessment tools to identify stroke symptoms and assess stroke patients in the field. Download stroke assessment tools.

3. NOTIFY

Observe transportation protocols and communicate with the hospital. EMS hospital pre-notification of incoming patients with potential stroke may reduce the time needed to evaluate and treat — which may improve treatment rates.⁶

4. ROUTE

Transfer to comprehensive stroke centers when available. Transportation to the right hospital may be the key in saving a patient from long term disability and death.⁶

LET’S WORK TOWARD A FUTURE WHERE STROKE IS LARGELY PREVENTABLE, TREATABLE, AND BEATABLE.

STROKE ASSESSMENT TOOLS

Use our downloadable tools to help you to identify stroke symptoms of stroke and access stroke patients in the field.

pdf Cincinnati Prehospital Stroke Scale (CPSS) (.pdf)

Download the CPSS.

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pdf Los Angeles Prehospital Stroke Screen (LAPSS) (.pdf)

Download the LAPSS.

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pdf Rapid Arterial Occlusion Evaluation Scale (RACE) (.pdf)

Download the RACE scale.

122KB

pdf Los Angeles Motor Stroke Scale (LAMS) (.pdf)

Download the LAMS.

143KB

pdf NIH Stroke Scale (NIHSS) (.pdf)

Download the NIHSS.

118KB

pdf Vision, Aphasia, Neglect Stroke Scale (VAN) (.pdf)

Download the VAN scale.

164KB

CONTINUING EDUCATION

EMS Practitioners

Medtronic offers free continuing education on acute ischemic stroke treatment for paramedics at www.americancme.com.

Khatri P, Abruzzo T, Yeatts SD, et al. Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology. September 29, 2009 2009;73(13):1066-1072.

Saver JL. Time Is Brain—Quantified. Stroke. January 1, 2006;37(1):263-266.

Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. Oct 2015;46(10):3020-3035.

⁴

SYNTHESIS Expansion, IMS III, MR RESCUE, MR CLEAN, ESCAPE, SWIFT PRIME, EXTEND-IA, and REVASCAT.

⁵

Maggiore, W. A. (2012). ‘Time is Brain’ in Prehospital Stroke Treatment. Journal of Emergency Medical Services, 1-9.

⁶

Lin CB, Peterson ED, Smith EE, et al. Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke. Circulation. Cardiovascular quality and outcomes. Jul 1 2012;5(4):514-522.