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Stroke--a time critical condition "if there's uncertainty, consider it an emergency".

Stroke in many instances is a preventable condition and must be considered a significant public health issue. Globally, stroke is the second most common cause of mortality and the third most common cause of disability. (1) Current literature supports stroke morbidity and mortality can be positively impacted through stroke prevention endeavors and standardization of evidence-based stroke treatment. As a time sensitive condition, it is also a leading cause of death and disability nationally and in West Virginia. In the United States, stroke is the fifth leading cause of death and a major cause of adult disability. (2) About 800,000 people in the United States have a stroke each year; one American dies from a stroke every four minutes, on average.

West Virginia Legislative Rule 64CSR27 allows Medical Command to direct West Virginia Emergency Medical Services (WVEMS) personnel to transport patients to the most appropriate facility and provides for the Categorization of Facilities for emergency care capabilities under the authority of the West Virginia Department of Health and Human Resources Office of Emergency Medical Services. (3) The establishment of facility categorization for emergency stroke care, similar to the West Virginia Trauma Center designation, establishes the capability of facilities according to their ability to provide emergency stroke care and assists WVEMS in transporting patients to a facility where optimal stroke care can be provided. To provide optimal care to West Virginia stroke victims during the acute event, stroke system of care design allows for the delivery of the right patient to the right facility in an ideal amount of time. Guidelines for stroke center categorization and emergency stroke care abilities at the individual West Virginia acute care facilities are defined based on established national standards. This stroke system of care will be West Virginia's second statewide "system of care." (4)

The three distinct phases of stroke care include Prevention, Acute Care, and Rehabilitation/Recovery. To a clinician, these phases must be considered and measures taken to incorporate all applicable stakeholders when developing a system that provides optimal stroke care. Communication and coordination of care across the care continuum is essential to achieve the goal of reducing stroke morbidity and mortality. A coordinated system of stroke care incorporating evidence-based guidelines and research is essential for stroke morbidity and mortality reduction.

Time lost is brain lost and the stroke time clock cannot be reset. Education for the general public and medical providers cannot be overemphasized. It is imperative to educate our patients that they or their loved ones should call 911 and activate the WVEMS system when any sign or symptom of stroke is present or if there is uncertainty about a sign or symptom. Aggressive attention and public education on modifiable stroke risk factors is needed since one of four stroke survivors suffer another stroke within five years. (5) The risk of stroke within 90 days of a transient ischemic attack (TIA) may be as high as 17%, with the greatest risk being in the first week. The challenge of cooperation amongst diverse and unique individuals and organizations when developing a system of quality stroke care seems miniscule when compared to challenges and struggles faced by individuals that have had a stroke.

References

(1.) Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-128.

(2.) Mozzafarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015:e29-322.

(3.) West Virginia Bureau For Public Health. Statewide Trauma / Emergency Care System. WV Legislative Rule 64CSR27.

(4.) Schwamm LH, Pancioli A, Acker JE 3rd. Recommendations for the establishment of stroke systems of care: recommendations from the American Stroke Association's Task Force on the Development of Stroke Systems. Circulation. 2005 Mar 1;111(8):1078-91.

(5.) Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation. 2012:e2-241

Rahul Gupta, MD, MPH, FACP

Commissioner and State Health Officer Bureau for Public Health, WVDHHR

Sherry L. Rockwell, RN, MSN

Director, Division of Trauma, Designation and Categorization Office of Emergency Medical Services Bureau for Public Health, WVDHHR
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Title Annotation:West Virginia Bureau for Public Health NEWS
Author:Gupta, Rahul; Rockwell, Sherry L.
Publication:West Virginia Medical Journal
Geographic Code:1U5WV
Date:May 1, 2015
Words:714
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