Diagnosis
Table 6. ED-Based Care
Action
Time
Door to physician
≤10 minutes
Door to stroke team
≤15 minutes
Door to CT initiation
≤25 minutes
Door to CT interpretation
≤45 minutes
Door to drug (≥80% compliance)
≤60 minutes
Door to stroke unit admission
≤3 hours
From Bock BF. http://www.ninds.nih.gov/news_and_events/proceedings/stroke_
proceedings/bock.htm. Accessed August 23, 2011.
ÎÎTo increase both the number of patients who are treated and the
quality of care, educational stroke programs for physicians, hospital
personnel, and EMS personnel are recommended (I-B).
ÎÎActivation of the 911 system by patients or other members of the
public is strongly recommended (I-B).
Note: 911 Dispatchers should make stroke a priority dispatch, and transport times
should be minimized.
ÎÎPrehospital care providers should use prehospital stroke
assessment tools, such as the Los Angeles Prehospital Stroke Screen
(www.strokecenter.org/wp-content/uploads/2011/08/LAPSS.pdf)
or Cincinnati Prehospital Stroke Scale (www.strokecenter.org/wpcontent/uploads/2011/08/cincinnati.pdf) (I-B).
ÎÎEMS personnel should begin the initial management of stroke in the
field, as outlined in Table 5 (I-B).
Note: Development of a stroke protocol to be used by EMS personnel is strongly
encouraged.
ÎÎPatients should be transported rapidly to the closest available
certified primary stroke center or comprehensive stroke center or, if
no such centers exist, the most appropriate institution that provides
emergency stroke care (I-A).
Note: In some instances, this may involve air medical transport and hospital bypass.
ÎÎEMS personnel should provide prehospital notification to the
receiving hospital that a potential stroke patient is en route so
that the appropriate hospital resources may be mobilized before
patient arrival (I-B).
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