Acute Stroke Systems Of Care
Outcomes for individuals with stroke have improved significantly due to the implementation of the Acute Stroke System of Care. The community is better equipped to recognize stroke as a “brain attack,” and there is greater awareness of the importance of medical care within three hours of symptom onset because you will have the opportunity to reverse said symptoms with the fibrinolytic. Likewise, EMS systems have been enhanced to transport individuals to regional stroke care centers that are equipped to administer fibrinolytics.
Stroke Chain of Survival
Figure 17
FAST Acronym
The FAST acronym is based on the Cincinnati Pre-Hospital Stroke Scale and is used to evaluate when someone is having a stroke.
| Face | Grimace or drooping on one side |
| Arms | Weakness drift or paralysis on the same side |
| Speech | Slurred or incomprehensible |
| Time | Time of activity and time to call 911 |
Table 2
Goals of Acute Ischemic Stroke Care
Stroke care is concerned with optimizing the patient’s recovery while simultaneously minimizing brain injury from the stroke. By focusing on transporting patients to stroke-capable centers, general results are improved. This is because stroke centers are much better equipped with the facilities and resources that smaller community hospitals may lack. Specialists such as stroke care specialists and neurologists, as well as multidisciplinary teams with advanced imaging modalities and several other therapeutic options, provide the best chances for a stroke victim’s survival and recovery. Within just 10 minutes, these specialized teams can examine and diagnose the patient who is suspected to have had a stroke.
The major steps of stroke diagnosis and treatment, as well as key points at which delays can occur, are highlighted in the 8 D’s of Stroke Care (Table 3).
The 8 D’s of Stroke Care
| Detection | Rapid recognition of stroke symptoms |
| Dispatch | Early activation and dispatch of EMS |
| Delivery | Rapid EMS identification, management, and transport |
| Door | Adhere to all door to delivery times, such as door to needle in < 60 minutes, etc. |
| Data | Rapid triage, evaluation, and management in ED |
| Decision | Stroke expertise and therapy selection |
| Drug | Fibrinolytic therapy, intra-arterial strategies |
| Disposition | Rapid admission to the stroke unit or critical care unit |
Table 3