Tessa Quinn
Stroke is a medical emergency, and rapid intervention is critical to improving patient outcomes. Brain cells die quickly without blood flow, so calling a stroke alert at a hospital is a way to quickly get the patient the resources they need for timely stroke intervention. Hospitals have created stroke alert systems to notify the appropriate team of providers about an acute stroke and to dedicate hospital resources to the immediate diagnosis and treatment of these patients. This includes an interventionist (neurosurgeon or interventional radiologist) on call at all times to perform procedures such as intra-arterial clot retrieval. When you call a stroke alert, the beepers of every member of the stroke team are activated, and the patient is quickly assessed so that appropriate therapy can be initiated.
| Characteristics | Values |
|---|---|
| When to call a stroke alert | As soon as you see evidence of a potential stroke, follow your facility's procedure for calling a stroke alert. Signs of a stroke can be remembered with the acronym BE FAST: Balance, Eyes, Face. |
| Who can call a stroke alert | Any hospital staff member may activate the hospital stroke alert system at any time if there is any concern of an acute stroke. |
| What happens when a stroke alert is called | The beepers of every member of the stroke team are activated. The patient is then quickly assessed by the stroke team so that appropriate therapy can be initiated. The stroke team typically consists of a neurologist with experience in vascular neurology, as well as a mid-level provider (physician assistant or nurse practitioner). For stroke alerts called outside the ER or ICU, an ICU nurse and a respiratory therapist also respond. |
| What is the purpose of a stroke alert | Providing appropriate care to patients with acute strokes as quickly as possible is critical in ensuring good outcomes. Hospitals have created "stroke alert" systems to notify the appropriate team of providers about an acute stroke and to dedicate hospital resources to the immediate diagnosis and treatment of these patients. |
| How to get to the hospital | Call 911 immediately. Brain cells die quickly without blood flow, so quick action is needed for the best chance of survival and recovery. |
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What You'll Learn
Recognising the signs of a stroke
Firstly, check the person's face. Ask them to smile and observe if one side of their face droops. This could be a sign of muscle weakness or paralysis, which often shows on just one side of the body. Secondly, ask the person to raise both arms. If one arm drops, this is another sign of one-sided weakness. Thirdly, ask the person to say a short phrase and check for slurred or strange speech. A stroke can impair a person's ability to talk clearly or choose their words.
If you observe any of these signs, call 911 right away. Remember to note the time when any symptoms first appear. This information is crucial for healthcare providers to determine the best treatment. Do not drive to the hospital or let the person experiencing symptoms drive themselves. Instead, call an ambulance so that medical personnel can begin administering treatment en route to the emergency room.
In addition to the FAST test, some health educators add two more steps, calling it the BE FAST test. "B" stands for balance, as a person having a stroke may experience a loss of balance. "E" stands for eyes, as there may be a sudden loss of vision in one or both eyes or blurry vision. It is important to note that stroke symptoms can sometimes be subtle and vary between men and women. Women, for instance, may experience headaches, weakness, and changes in thinking.
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Knowing when to call a stroke alert
The signs of a stroke can be remembered using the acronym BE FAST:
- Balance: Is the patient having trouble with their balance, standing, or sitting? Are they slumped over to one side? Did they fall? Is their gait normal? Do they seem to have a lack of coordination?
- Eyes: Has the patient experienced a sudden change in vision? Have they lost their field of vision entirely or in part? Has their vision become blurred? Are their pupils disparate (a late sign of severe injury)?
- Face: Does the patient have facial droop? Ask them to smile and assess the symmetry of their nasolabial folds. Ask them to close their eyes tightly and then open them wide while raising their eyebrows as high as they can.
Other stroke symptoms include a transient ischemic attack (TIA), commonly known as a mini-stroke. TIAs are warning strokes that precede about 15% of full-blown strokes and are often dismissed as symptoms only last a few minutes to 24 hours. Early interventions are vital after a TIA to reduce the risk of future strokes and other cardiovascular problems.
Additionally, some strokes are undetected, known as silent strokes, which occur when a blood vessel blockage in the brain causes cells to die without any warning signs or symptoms. These silent strokes are more common in older people, smokers, and those with a history of vascular disease.
If you suspect any of these signs or symptoms, it is essential to call a stroke alert immediately, following your facility's procedure. Do not hesitate to activate the hospital stroke alert system, even if you are unsure whether the patient is experiencing an acute stroke. Once activated, the stroke team will quickly assess the patient and initiate appropriate therapy.
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The role of EMTs
When someone is having a stroke, it is critical to call an ambulance (911 in North America) immediately. Brain cells die quickly without blood flow—for every minute a stroke is untreated, a person loses 1.9 million cells. Thus, rapid intervention is key in minimising neurological deficits and improving patient outcomes.
EMTs play a crucial role in this context. When EMTs arrive, they identify the patient and begin life-saving interventions, if necessary. They then perform a quick assessment using a prehospital stroke scale to determine whether the patient is having a stroke. If the patient is positive on the stroke scale, the EMTs may further evaluate for a type of blockage known as a large vessel occlusion (LVO). LVOs tend to cause more severe strokes that may require a higher level of care. During transport, an EMT will evaluate the patient, stabilise them if needed, and take measurements of vital signs such as temperature, pulse, blood pressure, and respiration rate. This information is then provided to hospital staff, saving valuable time.
Additionally, EMTs determine the most appropriate hospital for the patient's condition. They communicate with staff at an EMS communications centre, who relay the alert to the hospital, or directly with hospital staff, depending on the region. This triggers a stroke alert for the hospital's emergency medicine, neurology, pharmacy, and radiology teams to prepare the necessary resources, including a CT scanner for immediate brain imaging.
The time it takes for a stroke patient to reach the appropriate hospital can significantly impact their treatment options. Therefore, in cases where ground EMS response may cause significant delays, air transport should be considered.
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The stroke alert process in hospitals
Strokes are a medical emergency, and rapid intervention is critical to minimising neurological deficits and improving patient outcomes. When a stroke is suspected, it is important to act quickly to ensure the patient's safety and prevent additional complications. Hospitals have a "stroke alert" system in place to facilitate timely diagnosis and treatment.
Any hospital staff member can activate the hospital stroke alert system if they suspect a patient is experiencing a stroke. A low threshold for activation is encouraged, even if there is doubt about the patient's condition. Once activated, the entire stroke team is notified, and they quickly assess the patient to determine the appropriate therapy. The stroke team typically includes a neurologist with experience in vascular neurology, a physician assistant or nurse practitioner, an ICU nurse, and a respiratory therapist.
Before arriving at the hospital, EMTs play a crucial role in the stroke alert process. When EMTs receive a call for a suspected stroke, they immediately respond and begin lifesaving interventions if necessary. They perform a quick assessment using standardised criteria, such as the prehospital stroke scale, to determine if the patient is experiencing a stroke. If the patient shows signs of a stroke, EMTs may further evaluate for a large vessel occlusion (LVO), which can indicate a more severe stroke requiring advanced care. During transport, EMTs stabilise the patient, monitor vital signs, and communicate with hospital staff to facilitate a smooth transition upon arrival.
Once the patient reaches the hospital, the stroke alert system ensures rapid evaluation and treatment. The rate of stroke alerts and the subsequent diagnosis may vary depending on the time of day and patient location within the hospital. The stroke team conducts a thorough assessment, utilising standardised scales such as the NIHSS (National Institute of Health Stroke Scale), to confirm the diagnosis and determine the appropriate treatment plan.
Overall, the stroke alert process in hospitals is designed to prioritise speed and efficiency. By activating the stroke alert system, hospital staff can mobilise the necessary resources and expertise to provide timely intervention and improve patient outcomes. This coordinated effort between EMTs and hospital staff plays a crucial role in the treatment and management of stroke patients.
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The importance of timely intervention
Stroke is a medical emergency that requires immediate attention and intervention. When a person experiences a stroke, time is of the essence, as brain cells die quickly without blood flow. For every minute a stroke goes untreated, an estimated 1.9 million brain cells are lost, increasing the risk of lasting brain damage, long-term disability, or even death. Therefore, recognizing the signs of a stroke and acting promptly are crucial for improving patient outcomes and reducing the potential impact on the individual's cognitive and physical abilities.
The BE FAST or FAST acronym is a helpful tool for quickly identifying potential stroke symptoms:
- B alance: Is the person experiencing sudden difficulties with balance, standing, or sitting? Are they slumped to one side or having issues with coordination?
- E yes: Has the person suffered a sudden change in vision, such as blurred vision or loss of all or part of their field of vision?
- F ace: Does one side of the person's face droop when they try to smile?
- A rms: Can the person raise both arms evenly, or does one arm drift downward?
- S peech: Is the person having difficulty speaking or slurring their words?
- T ime: If you observe any of these signs, it's time to call for emergency assistance.
When you suspect that someone is having a stroke, calling for emergency medical services (EMS) by dialling 911 in the US or the local emergency number in other countries is crucial. EMS providers are trained to recognize and respond to stroke emergencies, and they can begin life-saving treatment while en route to the hospital. They will also coordinate with hospital staff to ensure a swift transition of care and provide valuable information that can expedite diagnosis and treatment upon arrival.
Additionally, it is essential to understand that even minor stroke symptoms require immediate attention. Transient ischemic attacks (TIAs), sometimes called "mini-strokes," are warning signs that should not be ignored. About 15% of strokes are preceded by a TIA, and early intervention can reduce the risk of subsequent, more severe strokes or other cardiovascular events. Therefore, seeking timely medical attention for any stroke-like symptoms, regardless of their duration or severity, is of utmost importance.
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Frequently asked questions
Call 911 immediately. Brain cells die quickly without blood flow, so quick action is required for the best chance of survival and recovery.
EMTs will arrive and identify the patient. They will then conduct a quick assessment to determine whether the patient is having a stroke. If the patient is positive on the stroke scale, the EMTs will further evaluate the type of blockage. During transport, the EMTs will also evaluate and stabilise the patient and take measurements of vital signs.
Signs of a stroke can be remembered using the acronym BE FAST: Balance, Eyes, Face, Arm, Speech, and Time. For example, is the patient having trouble with balance, standing or sitting? Has their vision changed suddenly? Does the patient have facial droop?
Once the hospital stroke alert system is activated, the beepers of every member of the stroke team are activated. The patient is then quickly assessed by the team so that appropriate therapy can be initiated. The team typically consists of a neurologist with experience in vascular neurology, a physician assistant or nurse practitioner, an ICU nurse, and a respiratory therapist.
The purpose of a stroke alert system is to quickly evaluate and treat patients with acute strokes. Hospitals have created these systems to ensure appropriate hospital resources are dedicated to the immediate diagnosis and treatment of these patients.
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