I characterize an effective meeting as one in which I learn things that I can put to use in my everyday practice of medicine or that help me to better understand some of the complexities in medicine that I do not fully understand. This meeting was helpful to me in both regards.
Dr. Crocco, the Chairman of the Department of Emergency Medicine at West Virginia University was the “lead-off” speaker for us on Friday morning. In his talk “Prehospital Stroke Management – Best Practices”, he described the seven key “D’s” in the stroke chain of survival: Detection (early recognition); Dispatch (early EMS activation); Delivery (transport and EMS management); Door (ED triage); Data (ED evaluation and management); Decision (Neurology input and therapy selection); and, Drug (Thrombolytic & future agents).
With regard to Detection, Dr. Crocco described some of his work concerning community stroke awareness in West Virginia. He realized that EMS personnel formed an ideal group to educate their own communities about stroke. For the most part, EMS personnel are knowledgeable about stroke and more importantly, they are very knowledgeable about the people in their own communities. He suggested that EMS groups formulate the message that needs to be presented to their community and then determine how best to spread that message.
EMS Dispatch is an area that physicians do not think about but may be key to the speed by which a stroke patient gets to the hospital. He noted that dispatch personnel generally work by template but that some of the templates such as for falls may not include the possibility that the fall could have been due to an acute stroke. Thus, after ascertaining that a fall occurred the dispatcher should also ask about focal neurological complaints.
Best practices, according to Dr. Crocco, include prehospital notification by EMS, early stroke team notification, use of a single call activation system, mixing thrombolytic agent ahead of time and establishing a data monitoring and feedback system.
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I will continue my discussion of other “pearls” from the Symposium in upcoming newsletters.
I am interested in obtaining feedback from the 2013 meeting as well as suggestions for talks for next year’s symposium. At the current time we are planning one or more talks on acute pediatric stroke (how a non – pediatric hospital stroke center should prepared to handle this) as well as an introduction to telemedicine. Dr. Lin has suggested one or more “debates” on controversial issues in acute stroke management.
Please let me know what you think are unmet needs for stroke education in Florida.
Jonathan Oren Harris MD (Course Director)
Please save the date and plan to attend the 2014 Florida Stroke Symposium, May 2– 3, 2014.