Review of: National Association of EMS Physicians. "The Role of EMS in the Management of Acute Stroke: Triage, Treatment and Stroke Systems." Prehospital Emergency Care. 11:312, 2007.
This week I present to you a position paper from the National Association of EMS Physicians (NAEMSP) that addresses the role of EMS in the treatment of stroke victims. The position paper is followed by two resource documents that provide the scientific foundation for the position paper. The position paper states the following;
The NAEMSP believes that:
Crocco TJ, Grotta JC, Jauch EC, et al: "EMS Management of Acute Stroke- Prehospital triage." Prehospital Emergency Care. 11:313-317, 2007.
Millin MG, Gullett T, Daya MR: "EMS Management of Acute Stroke-Out-of-hospital treatment and stroke system development." Prehospital Emergency Care. 11:318-325, 2007.
The American Heart Association (AHA) has made us all acutely aware of the need to expand our evaluation of patients to include detecting the signs and symptoms of stroke. The 2005 AHA Guidelines have provided extensive information on this topic but stopped short of providing specific information on how to implement a stroke detection and treatment program integrating the EMS and available medical resources.
The NAEMSP position clearly states what all of us already appreciate, but the accompanying resource documents provide us specific steps to develop a realistic prehospital stroke care system. This must include proper training of 9-1-1 dispatchers to detect the signs and symptoms of stroke and quickly mobilize EMS. Because the treatment window of strokes is relatively small, it's vital stroke patient be transported rapidly to a facility capable of performing a CT scan and determining whether the patient is a candidate for fibrinolytics.
This reminds me of what we went through when we first began to treat heart attacks. However, the treatment window and options are significantly greater for myocardial infarction than for stroke. Debate continues as to whether fibrionolytics are sufficient, but we will only know if we give our patients a chance to receive them. Future neuroscience research will more than likely mirror that of cardiology with the proliferation of new and better treatments.The biggest controversy facing EMS in the development of a stroke care system is creating policies and protocols to bypass closer hospitals in preference of hospitals with immediate availability to CT scans and medication. The role of air medical transport to facilitate such a program will also offer additional challenges.