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Kern County Stroke Center Policies – Implementation Training October 2008 Policies Effective – November 1, 2008 “Time is Brain” Objectives of the Policy Provide rapid evaluation and appropriate treatment for all eligible stroke cases in the shortest time possible.
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Policies Effective – November 1, 2008
“Time is Brain”
CEREBRAL VASCULAR ACCIDENT
RULE OUT HYPOGLYCEMIA AND NARCOSIS AS APPROPRIATE
ASSESS ONSET OF SIGNS OR SYMPTOMS
Total Time Since Onset of Signs or Symptoms:
ASSESS PATIENT IN ACCORDANCE WITH CINCINNATI PREHOSPITAL STROKE SCALE (CPSS)
Drooling from one side of mouth, eye movement dysfunction, tongue dysfunction are other indicators.
FACIAL DROOP (Have the Patient Show Teeth or Smile)
Indicative of hemiparesis (one-sided weakness) or hemiplegia (one sided paralysis).
ARM DRIFT (Patient Closes Eyes and Extends Both Arms Straight
Out, with Palms Up, for 10 Seconds)
- Normal: Both Arms Move the Same or Do Not Move at All
- Abnormal: One Arm does Not Move or One Arm Drifts Down Compared to
May also include a stroke patient that is unconscious or unresponsive.
ABNORMAL SPEECH (Have the Patient Say “You can’t teach an
old dog new tricks”)
- Normal: Patient Uses Correct Words with No Slurring of Words
- Abnormal: Patient Slurs Words, Uses Wrong Words, or is Unable to Speak
If ANY indicator is abnormal and the onset of signs or symptoms are within 3 hours, the appropriate stroke center is activated by contact of the designated stroke center emergency department.
IF ONE OR MORE ABNORMAL CPSS ARE PRESENT
ONSET OBSERVED WITHIN 3 HOURS BY VALID HISTORIAN;
QUESTIONABLE ONSET TIME
– EXPEDITE CONTACT WITH DESIGNATED STROKE CENTER BASE HOSPITAL
If the history of onset timing is not reliable or not available, the appropriate stroke center should be contacted and activated. The appropriate stroke center may also be contacted for advice as needed.
EOA #5: East, North, Central Bakersfield
EOA #2: Shafter, Buttonwillow
EOA #9: Taft, Maricopa, McKittrick
EOA #8: Lamont, Arvin, Frazier Park, Tehachapi
TRANSPORT AS FOLLOWS
EOA #3: Delano, McFarland. Woody
EOA #6: Kern River Valley, Isabella
EOA #8: Applicable to Tehachapi area and surrounding communities in the area.
BLS Ambulance: A stroke patient that meets Stroke Center Activation Protocol indications shall be transported to the closest hospital emergency department.
EOA #11: Mojave, California City, Rosamond, Boron & surrounding communities
Based upon Hall Critical Care Transport Medevac-1 from Meadows Field Bakersfield; or Mercy Air Service from Mojave.
Air transport shall be used if an air ambulance is available and the overall time savings will be 10 minutes or more in comparison with ground transport in compliance with EMS Aircraft Dispatch-Response-Utilization Policies and Procedures. Generally, 10 minutes time-savings cannot be attained with ground transport times of 30 minutes or less.
Generally, if a ground ambulance is within 30 minutes driving time from the Stroke Center, there will be no time savings by using an air ambulance.
A receiving or base hospital emergency department may request interfacility transfer of any stroke case meeting Stroke Center Activation Protocol criteria to a designated stroke center.
The designated stroke center cannot refuse to accept an interfacility transfer of a stroke case that meets Stroke Center Activation Protocol criteria.
Ground or air transport are at the discretion of the transferring physician.
A patient that meets Stroke Center Activation Protocol indications at a hospital that is not a designated stroke center should be transferred to a designated stroke center by the receiving hospital. If indicated, the receiving hospital shall notify the stroke center emergency department to activate response.
Ambulance Transport Destination Decision/Hospital ED Status Policies & Procedures:
A: Contact a designated stroke center, convey a patient information report, request advice regarding stroke center activation.
Q: If I have a patient with an onset of abnormal CPSS findings that were over 3 hours ago, but the history is suspect. What should I do?
A: Contact a designated stroke center, convey a patient information report, request advice regarding stroke center activation.Frequently Asked Questions
Q: I have a critical stroke patient with severe airway problems in the Tehachapi area that cannot be managed. Should I transport to a designated stroke center anyway?
A: No. Transport to the closest hospital emergency department in this case to secure the airway, then possibly interfacility transfer the patient to the designated stroke center.
Q: I have a patient with a past medical history of stroke 3 years ago reported by an extended care facility. The patient’s current complaint is headache for 2 hours with no other acute signs or symptoms. Should I activate and transport to a designated stroke center?
A: Not necessarily. This patient does not meet the Stroke Center Activation Protocol criteria for abnormal CTSS time of onset. This patient can be transported to any appropriate hospital emergency department, including a designated stroke center, according to standard procedures.
Q: I have a patient with an abnormal CPSS onset within 1 hour in the Kern Valley area. Kern Valley Hospital is 15 minutes away in transport time. An air ambulance has a 5 minute ETA to my current location. What should I do?
A: Have the patient transported by air ambulance.
Q: I have a patient with an abnormal CPSS onset within 2 hours in the California City area. AVHMC is 30 minutes away in ground transport time. A designated stroke center is 60 minutes away in ground transport time. An air ambulance has a 30 minute ETA to my current location but has not lifted off yet. I am ready to start transport. What should I do?
A: Begin ground transport toward AVHMC. It is important to make forward progress with the transport process. Waiting at an LZ for more than just a few minutes is generally excessive. Remember, time is brain.
Q: I am a physician at a receiving hospital emergency department and have an acute stroke patient that meets Stroke Center Activation Protocol indications. Do I have to transfer the patient to a designated stroke center?
A: It is recommended to transfer the patient immediately. However, if the responsible physician believes the patient can be managed adequately, that physician can certainly elect to not transfer the patient to a designated stroke center.
Kern County EMS Website:
Joint Commission of Healthcare (JCAH):
American Stroke Association:
The Brain Attack Coalition:
Please contact the Kern County EMS Department at 661-868-5201 or send an email to firstname.lastname@example.org with any questions regarding the Stroke Center Policies.