1. Pre-hospital Care In Stroke Todd J. Crocco, MD Director Division of EMS University of Cincinnati Cincinnati, OH

2. Todd Crocco, MD Stroke Chain of Survival & Recovery Detection Dispatch Delivery Door Data Decision Drug

3. Todd Crocco, MD Prehospital Stroke Survey Findings from a nationwide survey of paramedics and advanced EMTs: –TIA awareness is lacking –Many felt strokes could be managed non-emergently –Less than half were aware of the 3- hour time window Crocco, PEC, 1999

4. Todd Crocco, MD EMS Evaluation of Acute Stroke Paramedic diagnosis of stroke/TIA correct in 72% of cases EMS dispatchers correctly identify stroke/TIA in 52% of cases ED evaluation and CT scan times shorter for ALS vs. BLS responses Kothari, Stroke, 1995

5. Todd Crocco, MD The True Time of Onset Multiple sources –Friends, family, bystanders –EMS has unique opportunities to discover time of onset Times of reference –The time the basketball game started How normal were they? –Some patients will have previous neurologic deficits

6. Todd Crocco, MD Prehospital Stroke Assessment Cincinnati Prehospital Stroke Scale Los Angeles Prehospital Stroke Scale

7. Todd Crocco, MD The Impact Of 911 Barsan, Arch Int Med, 1993

8. Todd Crocco, MD Managing The Acute Stroke Patient Airway, Breathing, Circulation Assess vital signs Neurologic exam Check serum blood sugar Determine time of onset En route: IV, O2, monitor Notify the ED quickly Transport as soon as possible

9. Todd Crocco, MD And Remember… Do not delay transport Do not give large volumes of fluid (unless patient in shock) Do not give dextrose (unless hypoglycemic) Do not lower blood pressure Do not forget to determine time of onset

10. Todd Crocco, MD Stroke Treatment in 2000 Increased public education Development of protocols and teams Pivotal and expanding role of prehospital care

11. Todd Crocco, MD Stroke Summary EMS personnel deserve more stroke education Always determine the time of onset Call early, transfer immediately Stroke is an EMERGENCY!