EMS Models for Stoke EMS Models for Stoke Care: Care: Best Practices from CT and Around the Best Practices from CT and Around the United States United States Rommie L. Duckworth, LP Rommie L. Duckworth, LP 1
EMS stroke systems of care in the US
Nov 30, 2014
In the United States, current best practices for potential victims of stroke focus on the goals of rapid EMS triage of, transport to and treatment at Primary Stroke Centers. This session will address the following questions:
-What is the best EMS Stroke Care Model to accomplish this?
-Is there only one “Best Model”?
-How do models compare with other systems in neighboring states and elsewhere in the U.S.?
-What aspects of these other models might be adapted by EMS care systems to improve stroke care?
-What is the best EMS Stroke Care Model to accomplish this?
-Is there only one “Best Model”?
-How do models compare with other systems in neighboring states and elsewhere in the U.S.?
-What aspects of these other models might be adapted by EMS care systems to improve stroke care?
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EMS Models for Stoke Care:EMS Models for Stoke Care:Best Practices from CT and Around the United StatesBest Practices from CT and Around the United States
Rommie L. Duckworth, LPRommie L. Duckworth, LP1
Presenter Disclosure InformationPresenter Disclosure InformationRommie L. Duckworth, LPRommie L. Duckworth, LP
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FINANCIAL DISCLOSURE:[No relevant financial relationship exists]
UNLABELED/UNAPPROVED USES DISCLOSURE:[IA tPA, Surgical Clot Removal]
The sooner that rt-PA is given to stroke patients, the The sooner that rt-PA is given to stroke patients, the greater the benefit, especially if started within greater the benefit, especially if started within
90 minutes of symptom onset.90 minutes of symptom onset.
Target Stroke: Target Stroke: EMS & Acute CareEMS & Acute Care1
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Door-to-IV rt-PA within 60 minutes
GWTG-Stroke Database, data on file DCRI
Opportunity to Improve Timeliness Opportunity to Improve Timeliness of IV rt-PA in Ischemic Strokeof IV rt-PA in Ischemic Stroke
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% Stroke Patients who Receive rt-PA
Opportunity to Improve Admin. Opportunity to Improve Admin. of IV rt-PA in Ischemic Strokeof IV rt-PA in Ischemic Stroke
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ConnecticutConnecticut Comprehensive Plan for Comprehensive Plan for Stroke Prevention and Care GoalsStroke Prevention and Care Goals
• Plan Goal: Plan Goal: To create a coordinated system of stroke care and To create a coordinated system of stroke care and prevention in which it is possible for every Connecticut prevention in which it is possible for every Connecticut resident to access appropriate and timely care for optimal resident to access appropriate and timely care for optimal post stroke outcomes. A coordinated care system involves post stroke outcomes. A coordinated care system involves EMS, hospital stroke teams, specialized stroke units (where EMS, hospital stroke teams, specialized stroke units (where applicable), and standardized care protocols. applicable), and standardized care protocols.
• Emergency Medical Services (EMS): Emergency Medical Services (EMS): To facilitate timely access To facilitate timely access to EMS care, enhanced pre-hospital recognition and to EMS care, enhanced pre-hospital recognition and treatment, and rapid transport to the appropriate health care treatment, and rapid transport to the appropriate health care facility of patients experiencing a stroke event. facility of patients experiencing a stroke event.
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Copyright © American Heart Association
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Decrease Door to Treatment TimeDecrease Door to Treatment Time
• DispatchDispatch– Decrease Time To 911 NotificationDecrease Time To 911 Notification– Prioritizing EMS DispatchPrioritizing EMS Dispatch– Assuring Correct EMS ResourcesAssuring Correct EMS Resources
Decrease Door to Treatment TimeDecrease Door to Treatment Time
• NotificationNotification– Correctly Identifying Stroke In The FieldCorrectly Identifying Stroke In The Field– ED Pre-notification ED Pre-notification – Aggregating Data To Facilitate ED AssessmentAggregating Data To Facilitate ED Assessment
Decrease Door to Treatment TimeDecrease Door to Treatment Time
• Treatment / TransportTreatment / Transport– Triage To Best DestinationTriage To Best Destination– Extending The Time FrameExtending The Time Frame– Reducing The DistanceReducing The Distance
Which of these do you most see a need Which of these do you most see a need to improve in your organization?to improve in your organization?
①①DispatchDispatch②②NotificationNotification③③Treatment / TransportTreatment / Transport
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Which of these do you feel able to affect Which of these do you feel able to affect through your organization?through your organization?
①①DispatchDispatch②②NotificationNotification③③Treatment / TransportTreatment / Transport
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Psychosocial Barriers: Psychosocial Barriers: EMS StaffEMS Staff
How many EMS Staff barriers currently How many EMS Staff barriers currently affect your organization?affect your organization?
①①None of theseNone of these②②One of theseOne of these③③Many of theseMany of these④④All of theseAll of these⑤⑤OthersOthers
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Psychosocial Barriers: Psychosocial Barriers: ED StaffED Staff
• May be too busy to receive alertsMay be too busy to receive alerts• May be unfamiliar with EMS protocolsMay be unfamiliar with EMS protocols• May not trust EMS DxMay not trust EMS Dx• May see EMS over-triage as May see EMS over-triage as ““crying wolfcrying wolf””• May perceive poor hand-off information May perceive poor hand-off information • May have different in-house vs EMS criteriaMay have different in-house vs EMS criteria
How many ED Staff barriers currently How many ED Staff barriers currently affect your organization?affect your organization?
①①None of theseNone of these②②One of theseOne of these③③Many of theseMany of these④④All of theseAll of these⑤⑤OthersOthers
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Best Practices: Best Practices: DispatchDispatch
Best Practices: Best Practices: NotifyNotify
Best Practices: Best Practices: Triage / TreatmentTriage / Treatment
Best Practices: Best Practices: Triage / TreatmentTriage / Treatment
SummarySummary
Questions?Questions?
• Heather Duggan, RNHeather Duggan, RN– Stroke Coordinator, Western Connecticut Health NetworkStroke Coordinator, Western Connecticut Health Network
Special ThanksSpecial Thanks
• Rommie L. DuckworthRommie L. Duckworth– Director, New England Center for Rescue and Emergency MedicineDirector, New England Center for Rescue and Emergency Medicine– [email protected]– www.NECREM.orgwww.NECREM.org
ContactContact
11 The The Role of EMS in the Management of Acute Stroke: Triage,Role of EMS in the Management of Acute Stroke: Triage, Treatment, and Stroke Symptoms, Treatment, and Stroke Symptoms, NAEMSP Position StatementNAEMSP Position Statement, Prehospital Emergency Care, 2007, Prehospital Emergency Care, 20072 2 Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trialsNINDS rt-PA stroke trials, , Lancet.Lancet. 2004;363:768-74. 2004;363:768-74.3 3 Revised and Updated Recommendations for the Establishment of Primary Stroke Centers : A Revised and Updated Recommendations for the Establishment of Primary Stroke Centers : A Summary Statement From the Brain Attack Coalition, Summary Statement From the Brain Attack Coalition, Stroke.Stroke. 2011;published online, 2011 American 2011;published online, 2011 American Heart Association, Inc Heart Association, Inc 4 4 Data quality in the American Heart Association Get With The Guidelines-Stroke (GWTG-Stroke): Data quality in the American Heart Association Get With The Guidelines-Stroke (GWTG-Stroke): Results from a National Data Validation Audit, Results from a National Data Validation Audit, American Heart Journal. American Heart Journal. 2012;392-398, 2012 Elsevier2012;392-398, 2012 Elsevier5 5 Acute stroke care in the US:Results from 4 pilot prototypes of the Paul Coverdell National Acute Acute stroke care in the US:Results from 4 pilot prototypes of the Paul Coverdell National Acute Stroke Registry, Stroke Registry, StrokeStroke. 2005;36:1232-1240. . 2005;36:1232-1240. 6 6 Connecticut Comprehensive Plan for Stroke Care and Prevention 2009-2013,Connecticut Comprehensive Plan for Stroke Care and Prevention 2009-2013, 2009 Connecticut 2009 Connecticut Department of Public HealthDepartment of Public Health7 7 Translating Evidence Into Practice: A Decade of Efforts by the American Heart Translating Evidence Into Practice: A Decade of Efforts by the American Heart Association/American Stroke Association to Reduce Death and Disability Due to Stroke, Association/American Stroke Association to Reduce Death and Disability Due to Stroke, Stroke.Stroke. 2010;41:1051-1065, 2010 American Heart Association, Inc2010;41:1051-1065, 2010 American Heart Association, Inc8 8 Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous Tissue Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous Tissue Plasminogen Activator, Plasminogen Activator, Stroke.Stroke. 2009;40:2945-2948, 2009 American Heart Association, Inc 2009;40:2945-2948, 2009 American Heart Association, Inc
CitationsCitations
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