Hospital and EMS Stroke Care

Partnership: Data Collection, Education

and Feedback

Peter Canning, Paramedic, R.N.

EMS Coordinator

UCONN Health/John Dempsey Hospital

NorthEast Cerebrovascular Consortium 10th Annual Conference

October 22, 2015

Full-Time Paramedic in Hartford Since 1995

Part-time EMS Coordinator at UConn Since 2008

All-Time Zoey’s Dad

No Conflicts

UCONN Health/John Dempsey Hospital

Primary Stroke Center (2014)

Farmington, Connecticut

• 174 Beds

• 30,000 ED Visits a year

Stroke Modeled after STEMI Program

• STEMI Alert/Field

Activation

• Direct to CATH Lab

• Decreased D2B by 45%

• Mission Lifeline STEMI

Receiving Center Gold

EMS Stroke Plan

EMS Feedback for All Strokes and

Stroke Alerts (even if not a stroke)

Collected Data Points

• Dispatched Lights and Sirens

• Response within 8 Minutes

• ALS Care

• Stroke Recognized

• Cincinnati Stroke Scale

• Blood Glucose

• On Scene 15 Minutes of Less

• Last Known Well Time

• Transported Lights and Sirens

• Stroke Alert

• Stroke Alert to CAT Scan

• TPA

EMS Strokes (5 Quarters)

• 131 Strokes

109 Ischemic Strokes

22 Hemorrhagic Strokes

• 15 Received tPA (13.76% of Ischemic

strokes)

Early Data (1st 35 Strokes)

EMS Recognized Stroke

• 95.4% Cincinnati Stroke Scale

• 95.4% Blood Glucose

• 100% Last Known Well Time Documented

• 95.4% Stroke Alerts

• 100% Stroke Alerts Direct to CT Scan

• 100% ALS Care

EMS Radio Report- Sudden Confusion

Many strokes that did not have clear

Cincinnati Stroke Scale scores were being

missed.

Altered Mental Status

Focal Numbness

Fall

Dizzy with vomiting

Weakness

Vision Problems

Confusion

Encouraged Possible Stroke Alerts

Stroke Imitators:

Seizure, Dehydration/UTI, Transient Global Amnesia, Complex Migraine, Posterior

Reversible Encephalopathy, Bell’s Palsy, Psychosis, Brain Tumor

Review Dispatch Protocols

• Many possible strokes are sent “COLD” based on Emergency Medical Dispatch Protocols. If “Time is Brain,” these dispatch protocols need to be reviewed with each PSAP/EMD Center.

• Immediately met with local dispatch center, changed stroke response codes to HOT. Held later meetings with regional dispatch and did the same.

TPA patients

• 100% Dispatched on Priority

• 60% Transported on Priority

• 93% Came in on Stroke Alerts/Direct to CT

Recommendations

• Review Stroke Dispatch Protocols

• Educate Beyond Cincinnati Stroke Scale

• Encourage Priority Transport

• Direct to CT Scan with Stroke Alert

• Provide EMS Feedback

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