Stroke Awareness Month — enacting better protocols can save lives

Every 40 seconds, someone in the United States has a stroke. The moments after the stroke are a critical decision-making time for the family, friends, or first responders who encounter the patient. Many people’s first instinct would be to take their loved one to the closest hospital so they could be treated immediately; many first responders may consider this the best course of action as well.

The reality? The closest hospital is not always the best option.

{mosads}For patients who experience an ischemic stroke with emergent large vessel occlusion (ELVO) — a particularly severe stroke — the decisions made in the minutes and hours after a stroke can determine whether the patient will have lifelong disabilities or even die. If neuro-endovascular stroke surgery is performed in a timely fashion, the patient is more likely to not only live, but also return to a normal life.

Not all hospitals or stroke centers are equipped to provide this care, however, which means that if a patient goes to a facility without the capability to perform the surgery, their chance of recovery can be uncertain.

So, how can we ensure that all ELVO stroke patients can access neuro-endovascular stroke surgery and have the best possible chance of making a full recovery? We can provide the emergency medical services (EMS) personnel who triage and transport these patients with protocols that will help patients get to the right place the first time.

Recent research tells us that enacting such protocols at the state and local levels does make a difference. Drs. Mahesh Jayaraman and Ryan McTaggart, interventional neuro-radiologists at Rhode Island Hospital, led a recent study that evaluated stroke patient outcomes in Rhode Island as a result of changing the state’s transport rules and improving the stroke system of care. EMS protocols were updated to help first responders assess stroke severity in the field, enabling them to transport eligible patients directly to a Level 1 stroke center.

For ELVO patients who were taken to the nearest hospital or primary stroke center, just 42 percent experienced a favorable outcome, meaning that they had little or no disability and were able to live life as they had pre-stroke or without the need for daily help.

However, 62 percent of patients who were transported to a Level 1 stroke center, which has the capacity to provide neuroendovascular stroke surgery 24/7/365, experienced a favorable outcome.

Moreover, patients at the Level 1 stroke centers received surgery more quickly than those who were taken to primary stroke centers, even if they initially required additional transport time. Understanding these benefits, Arizona, Colorado, Massachusetts, Ohio, Tennessee, and Virginia are joining Rhode Island in changing the way they think about triage and transport so that severe stroke patients get to the right place the first time.

Getting patients to the right place matters. Decades ago, when states and localities adopted a Level 1 trauma center model, it was with the understanding that teams who are trained to treat traumas and see hundreds of cases a year are more likely to produce lifesaving results for patients. Today, EMTs take severe trauma patients directly to those facilities.

The standards should be no different for the nearly 800,000 people per year who experience a stroke in the U.S.

May is Stroke Awareness Month, a great time to show your support for stroke patients. Contact your local and state representatives, and explain the importance of improving stroke systems of care. Urge them to support clear protocols for stroke triage and transport. Adding your voice to the conversation can lead to the change we need.

Together, we can help more patients survive strokes

Blaise Baxter MD is the president of the Society of NeuroInterventional Surgery (SNIS), which has a political and advocacy campaign working across different states to improve stroke protocols. SNIS board members will meet with members of Congress and their staffs on May 8 in Washington, DC, about what legislators can do to help more patients access proper stroke care right away.