MACK HUTCHISON, BS, AS, NREMT-P
QUALITY MANAGER
HISTORY OF EMS
The good Samaritan rendered aid to a man laying
on the side of the road.
Napoleon’s chief physician was the first to develop
Pre-Hospital care in 1797.
The United States first recognized the need for
Pre-Hospital care after the first year of the Civil War.
HISTORY OF EMS
1971, the hit television show “Emergency” caught
the attention of the public prompting growing
concern for their health.
1985, Trauma became a concern for EMS
STROKE FACTS
•
Every 45 seconds someone in America has a
stroke.
•
About 700,000 Americans will have a new or
recurrent stroke this year and over 163,000 of
them will die (making it the third leading cause of
death in the USA).
•
There are approximately 266,000 stroke survivors
with permanent disabilities.
MORE STROKE FACTS
• Fewer than one in five Americans can identify
even one stroke symptom.
• The economic impact of stroke is estimated to
cost $40-$70 billion per year.
• A stroke can be devastating, that's why it's so
important to minimize your risk. “CALL 911”
CASE PRESENTATION
After returning home from the supermarket, a woman finds
her 67-year-old husband in the kitchen with slurred speech
and left-sided weakness. He was acting normally when she
left the house earlier that evening. She immediately calls her
friend across the street to ask for help. The friend arrives a
few minutes later only to find that the patient’s symptoms are
getting worse. They decide to call 911. EMS personnel arrive
within 5 minutes of the call. Paramedics evaluate the patient
and are concerned that the patient may be having a stroke.
What are the important elements of the pre-hospital
management of potential stroke patients?
STROKE PRESENTATION
OBJECTIVES:
• Describe the importance of rapid detection of
CVA/TIA symptoms in the pre-hospital setting
• Describe why extensive neurological
examinations are inappropriate in the prehospital setting
• Describe all points of the LA Stroke Scale
PRE-HOSPITAL MANAGEMENT
OF STROKE
•
•
•
•
Detection
Dispatch
Delivery
Door
PRE-HOSPITAL EMERGENCY CARE 1999
•
A lack of awareness/understanding of
TIAs
•
A common sentiment that strokes could be
managed non-emergently
•
Less than half of survey participants were
aware of the 3-hour time window for IV tPA.
TIME OF SYMPTOM ONSET
•
Question multiple sources
•
Actual time of symptoms vs. symptoms noticed
•
How normal were they?
•
Symptom onset: stuttering vs. acute
•
Baseline level of neurological function
LA PRE-HOSPITAL STROKE
SCREEN (LAPSS)
1. Age over 45 years
2. No prior history of seizure disorder
3. New onset of neurologic symptoms in last 24
hours
4. Patient was ambulatory at baseline (prior to
event)
5. Blood glucose between 60 and 400
ELECTRONIC LA STROKE SCALE
LAPSS
Exam: look for obvious asymmetry
Normal
Right
Facial smile/grimace: __
__ Droop
Left
__ Droop
Grip:
__
__ Weak Grip
__ No Grip
__ Weak Grip
__ No Grip
Arm weakness:
__
__ Drifts Down
__ Falls Rapidly
__ Drifts Down
__ Falls Rapidly
6. Based on exam, patient has only unilateral weakness: Y/N___
PRE-HOSPITAL CARE
•
•
•
•
•
•
•
Airway, Breathing, Circulation
Assess vital signs
Neurologic exam
Check serum blood sugar
Determine time of onset
Oxygen, IV, Monitor
Notify the ED quickly
WHAT NOT TO DO
•
Do not delay transport.
•
Do not give large volumes of fluid (unless the
patient is in shock).
•
Do not give dextrose (unless hypoglycemic).
•
Do not lower blood pressure.
•
Do not forget to determine time of onset.
CASE OUTCOME
When the paramedics arrived, their first action was to
evaluate the patient’s airway, breathing, and
circulation status. Since these were found to be
adequate, the patient’s vital signs were then
assessed. The results were as follows: blood pressure
= 180/96, heart rate = 106, and respiratory rate = 22.
While one paramedic then acquired some history from
the patient’s wife, the other paramedic performed a
concise physical examination which included a
Glasgow Coma Score (GCS) and a pre-hospital
stroke scale assessment.
CASE OUTCOME
(CONT’D)…….
Based upon the wife’s account, her husband was
acting normally 45 minutes earlier when she went
grocery shopping. He has never had symptoms like
this before and is otherwise a very healthy person.
She did not know what to do, so she called her
friend across the street. By the time she arrived, he
was getting worse, so she called 911. By this time,
the second paramedic has determined that the
patient has a GCS of 13 (E4 V3 M6). The prehospital stroke scale reveals the presence of leftsided facial droop, left-sided arm drift, and slurred
speech.
CASE OUTCOME
(CONT’D)……..
The paramedics then measure the patient’s blood sugar and
oxygen saturation. Both are found to be normal. They explain
to the patient’s wife that her husband appears to be having a
stroke. Time is critical, and they encourage her to come with
them since her assistance may be needed. The patient is
promptly transferred to the ambulance. While enroute to the
hospital, an IV is established, and the patient is placed on a
cardiac monitor and low flow oxygen. The receiving hospital is
contacted during the patient’s transport. Upon their arrival at
the Emergency Department, the staff have already vacated a
room and the physician begins evaluating the patient
immediately.
WHY YOU SHOULD CALL 911
FOR A STROKE
1.
Dispatchers will offer you verbal instructions.
2.
Treatment begins when the paramedic arrives.
3.
The ambulance is the most appropriate and safest
means of transportation.
4.
Inbound radio reports allow the hospital to get
ready.
5.
You are transported to the closest appropriate
hospital.
MYTHS OF EMS
*I can get to the hospital
before
an
ambulance
arrives!
*The ambulance is not
going to do anything but
take me to the hospital!
FACTS OF EMS
*Ambulance crews are trained
to deal with the medical
emergency that you are going
to the hospital for.
*Ambulances provide some of
the same life-saving care that
patients in emergency rooms
will receive.
*If you or your loved one go
unconscious enroute to the
hospital….what’s your plan?
SUMMARY:
• If you have signs of a stroke, the
ambulance is the best option for you.
• Treatment starts when you call.
• Treatment continues all the way to the
hospital.
• This sets up the best potential outcome for
you!
THANKS!....MACK HUTCHISON – MEMS QA MANAGER