Public awareness - How can we do better?
- Population-based studies demonstrate a lack of knowledge of stroke symptoms and warning signs which may impede pre-hospital management, treatment and preventive efforts.
- Public education campaigns are increasingly used to raise stroke awareness and aim to educate about the need to immediately call emergency services at the onset of suspected stroke.1
- Stroke awareness campaigns target people who might experience stroke symptoms, those who might witness stroke and often also primary care clinicians to optimise recognition and intervention for stroke.1
- In order to change response behaviours, public awareness campaigns should:
- Target the general public as stroke witnesses
- Raise symptom-awareness and awareness to take action
- Keep the message simple
- The ultimate aim is to keep the time to treatment as short as possible
- Public awareness campaigns can increase ambulance dispatches for stroke
Stroke chain of survival
- Early recognition of stroke warning signs may reduce treatment delays and, in the best case, decrease long-term disabilities.
- To support patients, family members, pre-hospital and emergency room personnel, the American Heart Association developed the Stroke Chain of Survival involving eight steps to be taken if someone is suffering a stroke.2
The 8 D’s of stroke care
- Effective EMS systems can minimise delays in pre-hospital dispatch, assessment, and transport, and ultimately increase the number of stroke patients reaching the hospital and being prepared for thrombolytic therapy within the approved time window.3,4
Cincinnati Pre-hospital Stroke Scale
The Cincinnati Pre-hospital Stroke Scale (CPSS) is a 3-item scale used to diagnose a potential stroke in a pre-hospital setting. It tests abnormalities in facial droop, arm drift and speech, which can be important indicators of a stroke.5
Hospital arrival times and thrombolysis rates in AIS patients according to mode of transport
The mode of transport to the emergency department has a huge impact on triage, diagnosis, and treatment of patients with stroke.6
The shortest pre-hospital time delays and highest thrombolysis rates were seen in ischaemic stroke patients transported by helicopter.6
Pre-admission notification by EMS: the best way to shorten door-to-needle time (DNT)
Pre-hospital notification by EMS may enable rapid dispatch and reduce intra-hospital processing times in cases of acute ischaemic stroke.7
- Saver JL. Time is brain--quantified. Stroke 2006;37:263–-66.
- González RG. Imaging-guided acute ischemic stroke therapy: From ‘time is brain’ to ‘physiology is brain’. AJNR Am J Neuroradiol 2006;27:728-735.
- Donnan GA, et al. Neuroimaging, the ischaemic penumbra, and selection of patients for acute stroke therapy. Lancet Neurol 2002;1:417–-25.
- Kaste M. et al. Organization of stroke care: education, stroke units and rehabilitation. European Stroke Initiative (EUSI). Cerebrovasc Dis Basel Switz 2000;10 Suppl 3:1-11.
- Kothari R. et al. Frequency and accuracy of prehospital diagnosis of acute stroke. Stroke 1995;26:937-941.
- Kothari RU., et al. Emergency physicians. Accuracy in the diagnosis of stroke. Stroke 1995;26:2238–2241.
- Act FAST. Stroke.org 2014. Available at: http://www.stroke.org/understand-stroke/recognizing-stroke/act-fast. Accessed April 16, 2018.
- Fonarow GC. et al. Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association’s Target: Stroke initiative. Stroke 2011;42:2983-2989.
- NINDS NIH website. Stroke proceedings. Latest update 2008.
- Personal communication, Peter Schellinger, Jan 2011.