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Pre-hospital Care in Stroke Todd J. Crocco, MD Director Division of EMS University of Cincinnati

Pre-hospital Care in Stroke Todd J. Crocco, MD Director Division of EMS University of Cincinnati Cincinnati, OH. Stroke Chain of Survival & Recovery. Detection Dispatch Delivery Door Data Decision Drug. Prehospital Stroke Survey.

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Pre-hospital Care in Stroke Todd J. Crocco, MD Director Division of EMS University of Cincinnati

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  1. Pre-hospital Care in Stroke Todd J. Crocco, MDDirector Division of EMS University of Cincinnati Cincinnati, OH

  2. Stroke Chainof Survival & Recovery • Detection • Dispatch • Delivery • Door • Data • Decision • Drug

  3. Prehospital Stroke Survey • Findings from a nationwide survey of paramedics and advanced EMTs: • TIA awareness is lacking • Many felt strokes could be managed non-emergently • Less than half were aware of the 3-hour time window Crocco, PEC, 1999

  4. EMS Evaluation of Acute Stroke • Paramedic diagnosis of stroke/TIA correct in 72% of cases • EMS dispatchers correctly identify stroke/TIA in 52% of cases • ED evaluation and CT scan times shorter for ALS vs. BLS responses Kothari, Stroke, 1995

  5. The True Time of Onset • Multiple sources • Friends, family, bystanders • EMS has unique opportunities to discover time of onset • Times of reference • The time the basketball game started • How normal were they? • Some patients will have previous neurologic deficits

  6. Prehospital Stroke Assessment • Cincinnati Prehospital Stroke Scale • Los Angeles Prehospital Stroke Scale

  7. The Impact Of 911 Barsan, Arch Int Med, 1993

  8. Managing The Acute Stroke Patient • Airway, Breathing, Circulation • Assess vital signs • Neurologic exam • Check serum blood sugar • Determine time of onset • En route: IV, O2, monitor • Notify the ED quickly • Transport as soon as possible

  9. And Remember… • Do not delay transport • Do not give large volumes of fluid (unless patient in shock) • Do not give dextrose (unless hypoglycemic) • Do not lower blood pressure • Do not forget to determine time of onset

  10. Stroke Treatment in 2000 • Increased public education • Development of protocols and teams • Pivotal and expanding role of prehospital care

  11. Stroke Summary • EMS personnel deserve more stroke education • Always determine the time of onset • Call early, transfer immediately • Stroke is an EMERGENCY!

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