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The policy provides a set of guidelines for EMS to rapidly evaluate potential stroke patients and, depending on the results and the location of the call, the response team can choose to transport the patient directly to a comprehensive stroke center, rather than a primary stroke center. This is important because certain treatments for acute ischemic strokes — such as endovascular therapy, an important treatment for large vessel occlusion — are only available at comprehensive stroke centers.
Endovascular therapy (EVT) involves threading tiny catheters through blood vessels in the groin or the wrist to the location of the blood clot causing the large vessel occlusion. The blood clot can then be removed using devices such as stents or aspiration catheters, in a procedure known as a thrombectomy, or dissolved using medications in a process called thrombolysis.
In the study, the researchers found that when EMS used a three-item stroke scale to quickly evaluate patients and direct those with a suspected large vessel occlusion directly to comprehensive stroke centers, there was a rapid increase in the number of patients who received EVT. Importantly, nearly three times as many patients received EVT after the new protocol was implemented compared to before. While the study did not look directly at patient outcomes, the investigators say that these results are promising.
“We know that the ischemic brain ages physiologically several years every hour treatment is delayed and that providing EVT reduces disability and death in patients by almost 20%,” said lead author Tareq Kass-Hout, MD, Assistant Professor and director of Endovascular Neurology at UChicago Medicine. “Since this treatment improves outcomes and policy changes such as ours increases the delivery of this powerful treatment, it is imperative that other regions also consider ways to implement routing policies to direct stroke patients to the appropriate stroke center. By doing this, there will be a major public health impact, because we know that the more EVT is used in a population, the more people are saved from disability and death.”
Prabhakaran hopes the study will inspire other regions to develop similar policies — and help Chicago patients understand that they can trust the response by EMS and need to react quickly when experiencing a stroke.
“Many people don’t realize that a stroke is an emergency that needs to be taken care of immediately,” said Prabhakaran. “The time lost in the first few hours can never come back. We need to teach our community that timely care is extremely important, and that patients shouldn’t need to figure out the right places to go on their own. Calling 9-1-1 should be enough to get patients the right level of care for their needs. We need to overcome the fears and doubts that people may feel about calling EMS and explain that we have policies in place that help people of all backgrounds get the emergency medical care they need. Based on these results, people should feel really confident that as a city, we’re able to provide the highest quality of stroke care possible.”
