Less than 10 percent of eligible stroke patients receive the lifesaving procedure they need to survive and thrive after stroke. That’s the core issue the Society of NeuroInterventional Surgery (SNIS) hoped to solve when it started the Get Ahead of Stroke campaign in 2016. The campaign works on the ground in states to enact protocols that enable EMS personnel to diagnose stroke severity in the field and take patients directly to the appropriate care so they have the best shot at surviving stroke and living a life without disability.
In commemoration of Brain Awareness Week, March 11–17, EMS World spoke with Scott McDaniel, a practicing paramedic and stroke survivor, and one of the Get Ahead of Stroke campaign’s members, to learn more.
EMS World: What is your personal connection to stroke and to this campaign?
McDaniel: In 2016, I was at work at Monroe County EMS in Waterloo, Illinois, and fell to the floor in the bathroom. I didn’t realize I was experiencing a severe ischemic ELVO stroke.
Luckily, the crew I work with took me to St. Anthony’s Medical Center in St. Louis—a hospital with 24/7/365 capability to provide neuroendovascular surgery. When I arrived at the hospital, the left side of my body was paralyzed. When I left, I walked out fully functional. After the surgery, I was only in the hospital for nine days and required minimal rehabilitation.
Looking back on my stroke has made me think about my children more often, and how close I came to not being able to care for them. It also reinforced that transporting stroke patients to appropriate care should rule the day.
As a paramedic, I know the decisions I make are critical to a patient’s well-being, and I appreciate that the Get Ahead of Stroke campaign sees the important role we play and gives us resources and tools so we can help our patients more effectively. At the end of the day, that’s why we do the work we do—to save lives and help people.
Why is neuroendovascular surgery central to this campaign?
This procedure uses catheters to quickly reopen blocked arteries in the brain. It can be performed in as little as 20 minutes. Studies published in the New England Journal of Medicine have proven that neuroendovascular surgery is highly effective at treating ischemic stroke patients with ELVO.1 In fact, life expectancy for patients who receive this specialized care increases by five years compared to patients who do not receive this care.2
Much of the public doesn't realize that my care was the exception, not the norm. More than 90 percent of ELVO patients don’t receive this procedure. We have enough doctors and facilities to offer this to all stroke patients who need it. That’s what the Get Ahead of Stroke campaign is trying to accomplish: Improve stroke systems of care so all severe stroke patients can receive this procedure.
Why does the campaign focus on changing triage and transport protocols?
Because it makes all the difference. In my case, being transported directly to a facility that was capable of providing neuroendovascular surgery meant I didn’t lose additional brain cells during a transfer between hospitals. Severe stroke patients gain a week of healthy life for every minute saved in getting them to appropriate care.3
Policies and regulations that guide stroke treatment vary widely by state. Currently, most states don't have protocols to ensure stroke patients go directly to a neuroendovascular-ready facility. So while a patient might live near one, they may be taken to a hospital that doesn’t have these specialized care teams.
How can EMS help connect severe stroke patients to appropriate care?
For trauma patients, the emergency response protocol requires immediate transport to the appropriate care that matches the level of severity. Just like with trauma, stroke is time-sensitive and requires a field severity assessment.
One tool the Get Ahead of Stroke campaign released last year to help assess stroke severity is a mobile app called Stroke Scales for EMS. By measuring, for example, the patient’s ability to squeeze and release a hand or make facial expressions—physical indicators of ELVO—the scales help first responders determine the best course of action. The app then recommends the type of facility where the patient can receive appropriate treatment. EMS providers can do their part by identifying their nearest comprehensive stroke centers so they can transport patients with ELVO directly to these centers.
What’s on the horizon for changes to stroke systems of care?
I’ve seen growing momentum across the country for adopting changes in stroke care protocols to ensure severe stroke patients have the best chance to survive and fully recover following a stroke. And I hope it spreads further! Virginia passed a resolution just last month that directed the Department of Health to take on stroke care quality improvement initiatives in the Commonwealth. Both Ohio and Tennessee have passed bills to improve the way first responders triage and transport severe stroke patients. A stroke resolution was unanimously passed by the Colorado Legislature, and Arizona updated its state protocols. I hope more states join this group and put stroke patients first.
1. Hacke, W. (2018). A new DAWN for imaging-based selection in the treatment of acute stroke. New England Journal of Medicine, 378: 81–83.
2. Moussavi, M., et al. (Feb. 16–19, 2016). Poster WMP12. Presented at International Stroke Conference, Los Angeles.
3. Meretoja, A., Keshtkaran, M., Tatlisumak, T., Donnan, G. A., & Churilov, L. (2017). Endovascular therapy for ischemic stroke: Save a minute—save a week. Neurology, 88(22): 2123–2127