Rooting L5

1. To increase both the number of patients who are treated

and the quality of care, educational stroke programs

for physicians, hospital personnel, and EMS personnel

are recommended (Class I; Level of Evidence B).

(Unchanged from the previous guideline)

2. Activation of the 911 system by patients or other members

of the public is strongly recommended (Class I;

Level of Evidence B). 911 Dispatchers should make

stroke a priority dispatch, and transport times should be

minimized. (Unchanged from the previous guideline)

3. Prehospital care providers should use prehospital stroke

assessment tools, such as the Los Angeles Prehospital

Stroke Screen or Cincinnati Prehospital Stroke Scale

(Class I; Level of Evidence B). (Unchanged from the

previous guideline)

4. EMS personnel should begin the initial management

of stroke in the field, as outlined in Table 4 in the full

text of the guideline (Class I; Level of Evidence B).

Development of a stroke protocol to be used by EMS

personnel is strongly encouraged. (Unchanged from the

previous guideline)

5. Patients should be transported rapidly to the closest

available certified primary stroke center or comprehensive

stroke center or, if no such centers exist, the most

appropriate institution that provides emergency stroke

care as described in the statement (Class I; Level of

Evidence A). In some instances, this may involve air

medical transport and hospital bypass. (Revised from the

previous guideline)

6. EMS personnel should provide prehospital notification

to the receiving hospital that a potential stroke patient is

en route so that the appropriate hospital resources may

be mobilized before patient arrival (Class I; Level of

Evidence B). (Revised from the previous guideline)

Designation of Stroke Centers and Stroke Care

Quality Improvement Process

1. The creation of primary stroke centers is recommended

(Class I; Level of Evidence B). The organization of such

resources will depend on local resources….. .

2. …

3. Healthcare institutions should organize a multidisciplinary

quality improvement committee to review and

monitor stroke care quality benchmarks, indicators,

evidence-based practices, and outcomes (Class I; Level

of Evidence B).

…..

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