Change is
Everywhere!
New approach to EMS delivery in Alberta
New EMS Provincial Medical Control Protocols
Introduction
Objectives
Define stroke
Describe acute ischemic stroke
Discuss EMS assessment and management of the suspected
stroke patient
Describe provincial stroke management protocol
Identify requirements for direct transport to the nearest Primary
or Comprehensive Stroke Centre
Explain the importance of rapid reperfusion
Describe how reperfusion is achieved
Case Study
Define Stroke
Stroke Syndrome sudden vascular event
leading to focal neurological dysfunction
Time is Brain
Used with permission by National Stroke Association
EMS Assessment
Primary Assessment
Vital signs
BGL
Medical history
o
o
o
o
o
Level of Consciousness
o A alert
o V verbal
o P painful
o U unconscious
Speech impairment - Aphasia
and dysarthia
Facial symetry - facial droop?
Arm weakness
o Limb drift
o Hemiplegia vs. hemiparesis
Leg weakness
o Limb drift
Vision abnormalities
Hand Grip Strength - non-specific
o
o
Medications
o
o
Previous coumadin
ASA
EMS Treatment
Airway management - ETI
Oxygen SPO2 > 95%
Positioning supine to 30 degrees
IV minimum1 large bore N/S at 100mL/hr
-no dextrose IV solutions
NO CT Scan
= No Thrombolytics
= No ASA
= No Anti-hypertensives
Early Notification
Prehospital recognition
=
Time to reperfusion
Time is Brain
Bypass Decision:
Rural/Suburban
- Bypass protocol in place, determines
closest PSC location
- Contacts ADCC if coming into
Edmonton for direction to CSC
- Transport to local PSC or to CSC with
pre-notification
- Consultation with Stroke
team/Telestroke
CT scan availability
Door to CT time less than 20 minutes with a pre-alert
Stroke expertise on-site or available by Telestroke link
r-tPA treatment availability
May not be available 24/7 due to CT/physician availability
Serves surrounding communities in which it is the nearest PSC
CT scan availability
Door to CT time less than 20 minutes with a pre-alert
Stroke team on-site
Neurological expertise on-site
Neurointerventional expertise on-site
Central hub of stroke Neurologist expertise in a telestroke network
- Penumbra device
Thank you
Alberta Provincial Stroke Strategy
AHS Emergency Medical Services Calgary Zone
Greg Vogelaar
Calgary Stroke Program:
Dr. Michael Hill
Darren Knapp
Paramedic/Quality Assurance Strategist
AHS Emergency Medical Services - Edmonton Zone
References
1. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency
cardiovascular care. Part 9: Adult stroke. Circulation. 2005;112:111-120.
2. Canadian Stroke Network and the Heart and Stroke Foundation of Canada: Canadian Stroke Strategy.
Canadian Best Practice Recommendations for Stroke Care: 2006. Ottawa, 2006.
3. Canadian best practice recommendations for stroke care (updated 2010) Patrice Lindsay, BScN
PhD, Mark Bayley, MD, Chelsea Hellings, BScH, Michael Hill, MSc MD, Elizabeth Woodbury, BCom
MHA, Stephen Phillips, MBBS (Canadian Stroke Strategy Best Practices and Standards Writing Group
on behalf of the Canadian Stroke Strategy, a joint initiative of the Canadian Stroke Network and the Heart
and Stroke Foundation of Canada*). FINAL v.25 October 21, 2010
4. EMS MANAGEMENT OF ACUTE STROKE PREHOSPITAL TRIAGE (RESOURCE DOCUMENT TO
NAEMSP POSITION STATEMENT)
5. T. J. Crocco, J. C. Grotta, E. C. Jauch, S. E. Kasner, R. U. Kothari, B. R. Larmon, J. L. Saver,M. R.
Sayre, S. M. Davis. ABSTRACT. PREHOSPITAL EMERGENCY CARE 2007;11:313317
6. Demchuk AM., Calgary Stroke Program Thrombolysis Update 2008 mostly a 3 to 4.5 hours post stroke
story. December 2007 Lecture presentation
7. Kidwell CS, Alger J, Saver JL. Beyond mismatch: Evolving paradigms in imaging the ischemic
penumbra with multimodal magnetic resonance imaging. Stroke. 2003; 34: 27292735
8. Saver JL. Time is brain--quantified Stroke. 2006 Jan;37(1):263-6. Epub 2005 Dec 8
9. Koeing KL Benefits of Pre-hospital Notification for Stroke Patients. Journal Watch Emergency
Medicine Nov 7, 2008
10. Alberta Provincial Stroke Strategy: Pre-Hospital Care February 2009
11. Government of Alberta Health and Wellness: Alberta Health Services: Emergency Medical Services:
Provincial Medical Control Protocols: Adult and Pediatric, December 1, 2010.