Ems toolkit
These findings underscore the challenges facing emergency systems of care. A similarly high misdiagnosis rate (61%) was documented for the responding EMS personnel when diagnosing stroke in Dispatch is a crucial link in the chain of care, yet dispatchers miss as many as 70% of stroke cases because they do not have the understanding or tools to properly assess the symptoms reported by callers. Symptoms, 2) treatment options, and 3) the need for quick therapy (5-8).ĭelays in treating stroke also occur because of poor recognition of stroke by 9-1-1 dispatchers and misdiagnosis of stroke by emergency medical services (EMS) personnel. Some of the factors in the delays include lack of knowledge regarding 1) stroke
One-half and three-quarters of ischemic stroke patients do not arrive at the hospital within the 3-hour window of treatment that is needed to make an assessment and begin therapy.
Retrospective studies have found that the biggest portion of the delay between onset of symptoms and emergency treatment is the time it takes for a patient to recognize the signs of stroke and decide to seek medical care (5-8). Reasons most frequently cited for not receiving treatment wereĭelays in 1) calling 9-1-1, 2) transporting patients to a hospital capable of handling stroke patients, andģ) diagnosing and treating patients after they arrive at the hospital (4). However, in 2004, only 3% to 8.5% of stroke victims received this Treatment for ischemic stroke, thrombolytic (“clot-busting”) therapy, wasĪpproved for use in the United States by the Food and Drug Administration inġ996 and works well if administered within the first 3 hours of the onset of Troubling, considering the promising stroke treatment options that exist. This high rate of death due to stroke before arrival at the hospital is Stroke, 49% of the patients died before being transported to a hospital (3). A follow-up study by CDC found that, although the stroke death rate decreased from 61.6 per 100,000 in 1999 to 56.2 per 100,000 in 2002, the percentage of out-of-hospital deaths was unchanged. The study found that ischemic strokes, those strokes caused by a blockage in an artery that supplies blood to the brain, accounted for 68% of all Ranged from 23% to 67%, and 8 states had proportions greater than 60%. The percentage of pretransport deaths by state
In 1999, approximately 48% of stroke deaths occurred pretransport (before transport to a hospital emergency department) (2). The Centers for Disease Control and Prevention (CDC) reported that Of whom die from stroke-related causes, and another 15% to 30% of whom remain permanently disabled (1). Each year, approximately 700,000 people suffer a first-time or recurrent stroke, approximately 25% Stroke is the third leading cause of death in the United States. We outline the issues surrounding acute stroke care, the role of emergency medical systems in strokeĬare, and the components of the EMS Acute Stroke Care Toolkit designed to improve EMS systems and outcomes for stroke patients. Toolkit helps each EMS system in defining, measuring, and analyzing their system of care and promotes collaboration through public education, regional stroke planning with hospitals, EMS service configuration, EMS staffing patterns, EMS education, and timely care delivery. Improvement Center, the agency that provides technical assistance for EMS in North Carolina. The EMS Acute Stroke Care Toolkit is being developed, tested, and implemented in all 100 counties in the state by the EMS Performance The Centers for Disease Control and Prevention is partnering with the National Association of Chronic Disease Directors and the North Carolina Office of EMS to design, develop, and implement an emergency medical services (EMS) performance improvement toolkit to evaluate opportunities to improve the emergency identification and treatment of acute stroke. An emergency medical services toolkit for improving systems of care for stroke in North Carolina. Suggested citation for this article: Williams I, Mears G, Raisor C, Wilson J. Ishmael Williams, Greg Mears, MD, FACEP, Cindy Raisor, BSN, MA, Jenny Wilson The North Carolina EMS Acute Stroke Care Toolkit An Emergency Medical Services Toolkit for Improving Systems of Care for Stroke in North Carolina