Outcomes for individuals with stroke have improved significantly due to the implementation of Acute Stroke System of Care. The community is better equipped to recognize stroke as a “brain attack,” and there is greater awareness of the importance of medical care within three hours of symptom onset because you will have the opportunity to reverse said symptoms with the fibrinolytic. Likewise, EMS systems have been enhanced to transport individuals to regional stroke care centers that are equipped to administer fibrinolytics.
Stroke Chain of Survival
Figure 17
FAST Acronym
The FAST acronym is based on the Cincinnati Pre-Hospital Stroke Scale and is used to evaluate when someone is having a stroke.
| FACE | Grimace or drooping on one side |
| ARMS | Weakness drift or paralysis on the same side |
| SPEECH | Slurred or incomprehensible |
| TIME | Time of activity and time to call 911 |
GOALS OF ACUTE ISCHEMIC STROKE CARE
The overall goal of stroke care is to minimize brain injury and optimize the individual’s recovery. Preferential transport to stroke-capable centers has been shown to improve outcomes. Stroke centers are equipped with resources often not available at smaller community hospitals. The presence of specialists, including neurologists and stroke care specialists, multidisciplinary teams experienced in stroke care, advanced imaging modalities, and other therapeutic options make transport to stroke centers the most suitable option. The goal of the stroke team, emergency physician, or other experts should be to assess the individual with suspected stroke within ten minutes.
The 8 D’s of Stroke Care (Table 2) highlight the major steps of diagnosis and treatment of stroke and key points at which delays can occur.
The 8 D’s of Stroke Care
| DETECTION | Rapid recognition of stroke symptoms |
| DISPATCH | Early activation and dispatch of EMS |
| DELIVERY | Rapid EMS identification, management, and transport |
| DOOR | Transport to stroke center within three hours of symptom onset |
| DATA | Rapid triage, evaluation, and management in ED |
| DECISION | Stroke expertise and therapy selection |
| DRUG | Fibrinolytic therapy, intra-arterial strategies |
| DISPOSITION | Rapid admission to the stroke unit or critical care unit |
Table 2