EMS Stroke Protocols in Lucas County (OH) Ahead of State Guidelines

The photo shows the front of a red ambulance.
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Ellie Buerk

The Blade, Toledo, Ohio

(MCT)

Time is brain.

So the common refrain of vascular doctors and emergency responders goes. The quicker a patient suffering a stroke receives treatment, the more likely they are to recover with less neurological damage.

For this reason, developing a protocol for how to evaluate stroke patients and move them quickly to the appropriate facility is critical.

Ohio Gov. Mike DeWine on Tuesday signed into law Senate Bill 21, which requires the state’s board of emergency medical, fire, and transportation services to adopt guidelines for the assessment, triage, and transport of stroke patients to hospitals. It also mandates that local emergency service organizations establish stroke protocols and provide training based on the board’s guidelines.

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For Lucas County, the bill simply codifies what has been common practice for more than five years.

“We’ve already been doing it,” said Brent Parquette, the training and quality improvement officer for Lucas County EMS. “We did most of our education back in 2015. Plus, we have ongoing education that we do yearly.”

Sine June, 2015, the county’s roughly 500 emergency medical personnel have been trained to evaluate patients using the RACE scale, a prehospital neurological scale that allows responders to detect acute stroke patients with a high probability of having a large vessel occlusion.

RACE-trained EMS personnel are able to quickly determine if a patient needs to be taken to a comprehensive stroke center rather then simply delivering that patient to the nearest emergency room.

Because it bypasses the sometimes hours-long process of re-transporting stroke patients by ambulance to correct facilities, the process saves an average of 100 minutes per case, said Dr. Mouhammad Jumaa, the medical director of ProMedica’s stroke network.

“We consider ourselves to be leaders in stroke care across the state,” Dr. Jumaa said. “A stroke is a very time-sensitive disease, so when a stroke happens, every minute counts.”

Strokes are the fifth leading cause of death in the United States and are a major contributor to long-term disability, according to the U.S. Centers for Disease Control and Prevention. Even a seven-minute delay in treatment reduces a patient’s chance for a good outcome by 1 percent, Dr. Jumaa said.

Dr. Jumaa traveled Tuesday to Columbus to join Mr. DeWine and others at a signing ceremony for Senate Bill 21. Dr. Jumaa has been a vocal advocate for the bill, as he’s witnessed firsthand how expedited intervention efforts in stroke cases can be life-saving.

“We’re making really good progress in terms of getting the right protocols throughout the state for triage of stroke patients,” he said. “Stroke, unlike trauma and heart attacks, was not very well regulated in terms of what patients should go to what hospital. A lot of places and a lot of states in many parts of the country have just taken patients to the closest hospital, which is always a challenge because the majority of hospitals in the country are not at a comprehensive stroke designation.”

Ohio identifies four designations for hospitals based on stroke care. Only comprehensive stroke centers have met the most demanding certification levels and can handle the most complex stroke cases.

Only 11 hospitals in Ohio carry this state designation, with two in the Toledo area: ProMedica Toledo Hospital and Mercy Health St. Vincent Medical Center.

“The other couple hundred hospitals really don’t have the resources to be able to take care of the sickest stroke patients,” Dr. Jumaa said.

Lucas County will serve as a model to guide counties without stroke protocols in place on how best to direct the transport of these patients, he added.

“Stroke care begins the moment a patient calls 911, and so we think there’s a huge opportunity for medics if they have the appropriate training and resources,” Dr. Jumaa said.

Lucas County’s RACE scale is a cost-effective and accessible alternative to mobile stroke units, emergency-transport vehicles equipped with computer tomography scanners and specialized teams trained in stroke treatment.

Mercy’s mobile stroke unit, the only one of its kind in the area, began doing runs around the same time the RACE protocol was initiated, said Dr. Eugene Lin, the unit’s medical director. It evaluated more than 1,200 patients so far.

While such vehicles have proven to help stroke victims recover with reduced disability and better outcomes than standard ambulances do, they’re expensive and, as a consequence, often hard to come by, especially in smaller, under-resourced areas of the state, Dr. Lin said.

“The RACE scale helps us better use scarce resources,” he said. “[The mobile unit] can be initiated by the EMS center when they get the initial stroke call, it can be initiated by the first responders themselves, and it can always rendezvous with the individual EMS units that are outside of Lucas County…. With [the RACE] system in place we don’t have miss a stroke patient that could get to the hospital sooner rather than waiting on the mobile stroke unit.”

First Published June 27, 2021, 9:50am


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