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Minnesota Acute Stroke System Council. February 22, 2012. Agenda. Destination Protocol Update Stroke Units Other updates. Destination Protocol. Old Draft (December): problems with incorporating time-to-destination decision points, distinguishing hospital type destinations

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Presentation Transcript

Agenda
Agenda

  • Destination Protocol Update

  • Stroke Units

  • Other updates


Destination protocol
Destination Protocol

  • Old Draft (December): problems with incorporating time-to-destination decision points, distinguishing hospital type destinations

  • Steering Committee discussion (2/6/2012):

    • Simplify!

    • Develop a ‘statewide’ protocol

    • Local EMS should submit a ‘local’ protocol consistent with statewide protocol

    • Develop state map of designated hospitals

    • Basically: Within six hours: patients should be transported to nearest designated hospital

  • Model: New York State BLS protocol (see next slide)


Draft destination protocol 1
Draft destination protocol (1)

  • Perform initial assessment.

  • Assure that the patient’s airway is open and that breathing and circulation areadequate.

  • Administer high concentration oxygen, suction as necessary, and be prepared to assist ventilations.

  • Position patient with head and chest elevated or position of comfort, unless doing so compromises the airway.

  • Perform Cincinnati Pre-Hospital Stroke Scale:

    • Assess for facial droop: have the patient show teeth or smile,

    • Assess for arm drift: have the patient close eyes and hold both arms straight out for 10 seconds,

    • Assess for abnormal speech: have the patient say, “you can’t teach an old dog new tricks”.


Draft destination protocol 2
Draft destination protocol (2)

  • If the findings of the Cincinnati pre-hospital stroke scale are positive, establish onset of signs and symptoms by asking the following:

    • To patient – “When was the last time you remember before you became weak, paralyzed, or unable to speak clearly?”

    • To family or bystander – “When was the last time you remember before the patient became weak, paralyzed, or unable to speak clearly?”

  • Transport of patient’s with signs and symptoms of stroke to the appropriate hospital:

    • Transport the patient to the closest Minnesota Department of Health designated Stroke Center if the total pre-hospital time (time from when the patient’s symptoms and/or signs first began to when the patient is expected to arrive at the Stroke Center) is less than six (6) hours.

    • Transport the patient to the closest appropriate hospital emergency department (ED) if:

      • The patient is in cardiac arrest, or

      • The patient has an unmanageable airway, or

      • The patient has (an) other medical condition(s) that warrant(s) transport to the closest appropriate hospital emergency department (ED) as per protocol, or

      • The total pre-hospital time (time from when the patient’s symptoms and/or signs first began to when the patient is expected to arrive at the Stroke Center) is greater than six (6) hours, or

      • An on-line medical control physician so directs.


Draft destination protocol 3
Draft Destination protocol (3)

  • Maintain normal body temperature; do not overly warm the patient.

  • Protect any paralyzed or partially paralyzed extremities.

  • Ongoing assessment. Obtain and record the patient’s initial vital signs, repeat en route as often as the situation indicates.

  • Notify the receiving hospital as soon as possible of your impending arrival with an acute stroke patient, Cincinnati Stroke Scale findings, and time signs and symptoms began.

  • Record all patient care information, including the patient’s medical history and all treatment provided, on a Pre-hospital Care Report (PCR).


Stroke units criteria draft
Stroke units: criteria (draft)

  • Defined group of beds/staff/protocols

  • Does not need to be distinct ward or unit

  • Staffed with personnel trained in stroke

  • Continuous multichannel telemetry

  • Written care protocols

  • Documentation on staffing and operations


Stroke units issues
Stroke Units: issues

  • Stroke unit is mainly about structure, organization, and nursing expertise

  • Current definition only addresses acute medical management

  • Needs to also address:

    • Ability to provide patient education

    • Ability to prevent complications

    • Ability to prevent extension of stroke

    • Early rehabilitation

  • Acute stroke-ready hospitals should be able to meet all criteria for admitted patients

  • ASR hospitals can meet criteria by having formal consult relationship with external experts/specialists


Stroke units discussion
Stroke units: discussion

  • Acute stroke ready hospitals: challenges in meeting criteria?

  • Other issues?

  • Consensus

  • Create a new/final checklist (criteria)


Next steps reminders
Next Steps, Reminders

  • Next teleconference: March 21, 2012 (noon on third Wednesdays)

  • Upcoming conferences, meetings, and presentations

    • Minnesota Hospital Association Rural Hospital Committee, Plymouth: 3/7

    • MN ACEP, Location TBD: 3/19

    • Minnesota Stroke Conference, St. Paul: 6/4

    • Minnesota Rural Health Conference, Duluth: 6/26

    • MN EMS Medical Directors Conference, Alexandria: 9/7-9

  • Submit concerns and questions:

    • Email ([email protected])

    • Online: http://www.health.state.mn.us/divs/hpcd/chp/cvh/strokesystemcomment.cfm


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