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On the Scene

Volume 4, Issue 2

EMS is key to stroke survival

Colleen Lechtenberg, MD
Stroke program medical director

Rapid recognition and transport to the appropriate hospital for emergency stroke care significantly improves stroke outcomes. Thank you for being part of the team that provides the best possible outcomes for patients in our region!

Recently revised stroke guidelines outline the importance of EMS in the stroke chain of survival (see additional recommended guidelines). Two new recommendations for EMS personnel related to managing patients with acute ischemic stroke are:

  • Patients should be transported rapidly to the closest available certified primary stroke center or comprehensive stroke center or, if no such centers exist, the most appropriate institution that provides emergency stroke care as described in the statement (Class I; Level of Evidence A). In some instances, this may involve air medical transport and hospital bypass.
  • EMS personnel should provide prehospital notification to the receiving hospital that a potential stroke patient is en route so that the appropriate hospital resources may be mobilized before patient arrival (Class I; Level of Evidence B).
Source: Guidelines for the Early Management of Patients with Acute Ischemic Stroke

Additional recommended stroke guidelines

Recommended
  • Assess and manage ABCs
  • Initiate cardiac monitoring
  • Provide supplemental oxygen to maintain O₂ saturation greater than 94 percent
  • Establish IV access per local protocol
  • Determine blood glucose and treat accordingly
  • Determine time of symptom onset or last known normal, and obtain family contact information, preferably a cell phone number
  • Notify hospital of pending stroke patient arrival
  • Triage and rapidly transport patient to nearest, most appropriate stroke hospital or healthcare facility
Not Recommended
  • Do not initiate interventions for hypertension unless directed by medical command
  • Do not administer excessive IV fluids
  • Do not administer dextrose-containing fluids in nonhypoglycemic patients
  • Do not administer medication by mouth (maintain NPO)
  • Do not delay transport for prehospital interventions

Hospital recognized for stroke care

The University of Kansas Hospital is one of the first in the country to be recognized as a Comprehensive Stroke Center. These centers provide the same level of care as Primary Stroke Centers and also offer neurointerventional stroke treatments 24/7. They also feature a specialty-trained stroke team and neurocritical care to ensure the most comprehensive treatment and best possible outcomes.

Here, patients can receive interventional stroke care such as the Merci Retrieval System®, Penumbra System®, Solitaire™ and Trevo® thrombectomy clot retrieval devices. In addition, patients with acute ischemic stroke resulting from cervical atherosclerosis or dissection can be treated with emergent intracranial angioplasty and/or stenting. Patients with hemorrhagic stroke may be treated with endovascular coiling or the Pipeline™ stenting device.


Meet Leavenworth County EMS

Leavenworth County Emergency Medical Service was established in 1976 as a basic life support service. It has provided advanced life support ambulance service to Leavenworth County residents since 1982. In addition it has:
  • 31 line technicians
  • Director, assistant director and operations officer – all certified paramedics – plus business manager, data entry/billing clerk and receptionist
  • Emergency and nonemergency services to all of Leavenworth County, Fort Leavenworth and the three prisons
  • Average of 15 calls per day – more than 7,000 calls each year
  • Minimum of 4 advanced life support ambulance stations staffed 24 hours a day
  • 3 stations – 2 in Leavenworth and 1 in Tonganoxie
  • Administrative offices at the main station on Eisenhower Road in Leavenworth