North Carolina updates stroke triage and transport protocol


North Carolina has updated its emergency stroke care protocol—a move applauded by the Get Ahead of Stroke campaign. The protocol, which went into effect on 15 October 2021, will change the way first responders triage and transport severe stroke patients across the US state, and aims to reduce death and disability by improving timely access to treatment via minimally invasive mechanical thrombectomy procedures for these patients.

The Stroke and LVO [large vessel occlusion] Stroke EMS [emergency medical services] Triage and Destination Plan will help ensure that patients experiencing a severe stroke—including a deadly ischaemic stroke such as an LVO—will be effectively triaged and transported to the hospital that is best-equipped to treat them, according to a press release.

Until now, the state did not have specific guidance in place to help ensure these particular patients were triaged and transported to a Level 1 stroke centre, which is considered the most appropriate care facility for treating LVO. The updated protocol will help “minimise the time from stroke onset to definitive care”, the release adds.

“I can attest to the impact of transport delays on prolonging and exacerbating the effects of stroke,” said Katyucia de Macedo Rodrigues, a neurointerventionist at Greensboro Radiology, Cone Health Moses Cone Hospital (Greensboro, USA), and member of the Society of NeuroInterventional Surgery (SNIS). “For every minute of delay in treating severe ischaemic stroke such as LVO, two million brain cells die. With each hour that passes before the patient is properly treated, the brain loses as many neurons as it does in almost 3.6 years of normal ageing.”

The updated protocol was developed through a collaborative effort involving members of SNIS, the Justus-Warren Heart Disease and Stroke Prevention Task Force, and the North Carolina Division of Public Health. It advises EMS to utilise a stroke severity tool and score when conducting an initial assessment of a stroke patient. If there is a high likelihood the patient has an LVO, based on their severity score, EMS should transport them directly to a Level 1 stroke centre.

The protocol allows flexibility for each EMS agency to collaborate with stroke centres to where they routinely transport patients in developing guidelines most appropriate for the region based on geography and available stroke resources. The Get Ahead of Stroke campaign, a national public education and advocacy campaign designed to improve systems of care for stroke patients, says the updated protocol will help improve North Carolinians’ chances of surviving severe stroke, as well as lower the immense costs associated with long-term care and rehabilitation services.

“We commend our SNIS colleagues as well as the Justus-Warren Heart Disease and Stroke Prevention Task Force, State Senator Jim Perry (R-7), and the North Carolina Division of Public Health, for their commitment and dedication to improving how patients afflicted with severe stroke are triaged and transported in the state,” said Michael Chen, a neurointerventionist at Rush University Medical Center (Chicago, USA) and SNIS president. “It is a remarkable achievement that residents of North Carolina should be proud of.”

Similar protocols addressing the unique, time-sensitive needs of stroke patients with LVO have also been adopted in other US states including Arizona, Colorado, Florida and Tennessee, and are in process in Ohio. The Get Ahead of Stroke campaign is currently supporting similar protocol changes in Massachusetts, Michigan and Pennsylvania too.


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