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Rapid transport is the key to timely treatment

EMS is critical in the management of suspected stroke
The goal of stroke care is to minimize brain injury and maximize patient recovery. To initiate this process, the American Heart Association/American Stroke Association have developed the stroke systems of care. This community-oriented program links patients, family members, and healthcare providers to maximize stroke recovery.1

Stroke systems of care2

Effective prehospital systems are crucial in stroke systems of care1

Stroke systems of care(2)

Effective EMS systems can minimize delays in prehospital dispatch, assessment, and transport, and ultimately increase the number of patients reaching the hospital within the 3-hour treatment window for fibrinolytic therapy.2-4

Guidelines for EMS management of patients with suspected stroke2

The 2007 AHA/ASA guidelines outline the role of EMS upon arrival and en-route to the hospital

On sceneIn transit
Manage ABCs: airway, breathing, circulation — give oxygen, if needed Rapid transport to closest facility capable of treating stroke* Check and record blood glucose to assess for hypoglycemia
Perform prehospital stroke assessment Bring witness, family member, or caregiver, if possible Check and record blood pressure
Establish and record exact time when patient last seen normal Alert receiving emergency department Establish cardiac monitoring and IV access, if possible
  • *
  • EMS bypass of hospital without stroke resources supported by guidelines if a stroke center is within reasonable transport range2


EMS fact sheetEMS Fact Sheet — provides emergency services personnel with at-a-glance guidelines designed to help assess and manage suspected stroke patients both on the scene and in transit. This fact sheet includes 2 prehospital stroke assessment scales as well as information on Activase (Alteplase)

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Find more information on prehospital care through the Stroke Rapid Response™ program3

The Stroke Rapid Response™ program is a 2-hour training program for prehospital providers through the National Stroke Association.

Goals3

  1. Increase and maintain prehospital providers' knowledge of stroke
  2. Increase recognition of stroke signs and symptoms on scene
  3. Increase the occurrence of EMS calls identifying symptoms as "possible stroke/cerebrovascular accident"
  4. To facilitate delivery of stroke patients to the nearest appropriate hospitals including recognized stroke centers
  5. Reduce transit time and time to treatment


More information can be found at www.stroke.org

Genentech is neither affiliated with nor endorses any of these organizations.

Indication
Activase (Alteplase) is indicated for the management of acute ischemic stroke in adults for improving neurological recovery and reducing the incidence of disability. Treatment should only be initiated within 3 hours after the onset of stroke symptoms, and after exclusion of intracranial hemorrhage by a cranial computerized tomography (CT) scan or other diagnostic imaging method sensitive for the presence of hemorrhage (see CONTRAINDICATIONS).

Safety Information
Activase therapy in patients with AIS is contraindicated in certain situations (eg, suspicion of subarachnoid hemorrhage on pretreatment evaluation, recent (within 3 months) intracranial or intraspinal surgery, history of intracranial hemorrhage, uncontrolled hypertension at time of treatment, active internal bleeding, known bleeding diathesis (eg, current use of oral anticoagulants, administration of heparin within 48 hours of onset of stroke, platelet count <100,000) (see CONTRAINDICATIONS for full list).

The most common complication during Activase therapy is bleeding. Should serious bleeding in a critical location (intracranial, gastrointestinal, retroperitoneal, pericardial) occur, Activase therapy should be discontinued immediately. Death and permanent disability are not uncommonly reported in patients who have experienced stroke (including intracranial bleeding) and other serious bleeding episodes.

The risks of Activase therapy may be increased and should be weighed against the anticipated benefits in certain conditions. [See WARNINGS in full prescribing information].

  • Patients with severe neurological deficit (eg, NIHSS >22) at presentation. There is an increased risk of intracranial hemorrhage in these patients.
  • Patients with major early infarct signs on a computerized cranial tomography (CT) scan (eg, substantial edema, mass effect, or midline shift).

Treatment of patients with minor neurological deficit or with rapidly improving symptoms is not recommended.

Orolingual angioedema has been observed in postmarketing experience in patients treated with Activase for AIS. Patients should be monitored during and for several hours after infusion for signs of orolingual angioedema.

Please click here for full prescribing information.
References:
1.
Adams HP Jr, Del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke. Stroke. 2007;38:1655-1711.
2.
American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 9: adult stroke. Circulation. 2005;112:IV-111-IV-120.
3.
Wojner-Alexandrov AW, Alexandrov AV, Rodriquez D, Persse D, Grotta JC. Houston paramedic and emergency stroke treatment and outcomes study H.PSTO. Stroke. 2005;36:1512-1518.
4.
Deng YZ, Reeves MJ, Jacobs BS, et al. IV tissue plasminogen activator use in acute stroke: experience from a statewide registry. Neurology. 2006;66:306-312.