COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

DATE:

June 4, 2007

BOARD MEETING DATE:

June 19, 2007

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

 

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director, Health Department

Barbara Pletz, EMS Administrator

   

SUBJECT:

Stroke Center Policy

 

RECOMMENDATION:

Adopt a Resolution authorizing Emergency Medical Services (EMS) to implement a stroke center policy directing ambulances to transport acute stroke patients to stroke centers.

 

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all.

Goal 5: Residents have access to healthcare and preventive care.

 

The stroke system contributes to the goal by improving emergency services provided to individuals with behavioral emergencies in the field.

 

Performance Measure:

Measure

FY 2006-07
Estimated

FY 2007-08
Projected

Percent of patients with acute stroke symptoms taken to a stroke center

5%

90%

 

BACKGROUND:

Approximately 700,000 Americans suffer a stroke each year. Of the 80% who survive their stroke, many are left with disabilities. Until recently there was nothing that could be done to effectively treat an acute stroke. The medical management of strokes was directed at comfort measures followed by rehabilitation.

 

Definitive treatment of stroke is now possible in many instances if the treatment is given soon enough. For strokes caused by a blockage of blood flow to the brain, a drug that dissolves blood clots (t-PA) can be given if the symptoms are less than three hours in duration. If more than three hours have passed since the symptoms began, some patients may benefit from invasive procedures in which a catheter is threaded into the brain’s blood vessels and the blood clot is removed. Although any hospital emergency department can administer t-PA, research studies published in medical journals report that few patients who could potentially benefit receive this medication. If a hospital has made stroke care a priority and has implemented quality measures for excellence in stroke care, it is likely that timely and appropriate stroke treatment will occur.

 

The Joint Commission on Accreditation for Healthcare Organizations (Joint Commission) has implemented a process for hospitals to receive accreditation as a Primary Stroke Center. Kaiser Redwood City, Mills-Peninsula Hospital, Seton Medical Center, and Stanford have achieved this Primary Stroke Center accreditation. Two of these hospitals, Kaiser Redwood City and Stanford, have the capability of performing the invasive procedures to remove blood clots from the brain’s circulation.

 

DISCUSSION:

The EMS Agency is proposing an ambulance transport policy that will direct ambulances with acute stroke patients to:

 

    A Primary Stroke Center if the onset of symptoms is less than 2.5 hours;

    Kaiser Redwood City or Stanford if onset of symptoms is longer than 2.5 hours but shorter than 8 hours;

    The closest hospital if onset of symptoms is longer than 8 hours.

 

Mills-Peninsula Hospital and Seton Medical Center are both planning to begin performing the invasive procedures in the future. Once they are able to offer this comprehensive standard of care, they will receive patients with symptoms of longer duration.

 

A 6-month sample of 9-1-1 ambulance patients was reviewed to determine the number of acute stroke patients in the less than 3-hour window and the greater than 2.5-hour but less than 8-hour window. The number of patients with symptoms less than 3 hours was 33, and the number with symptoms between 3 to 8 hours was 9. An additional 22 patients did not enter the 9-1-1 system until more than 8 hours after the onset of symptoms.

 

We are working collaboratively with our stroke center hospitals to communicate with the media and to prepare educational materials for the public. Messages will focus on:

 

    Emphasizing that disability caused by stroke can be prevented or mitigated if the patient seeks rapid medical treatment

    Recognizing stroke symptoms

    Calling 9-1-1 if a stroke is suspected

 

A position paper providing more detail on strokes and the stroke system of care is included as Attachment A.

 

FISCAL IMPACT:

There is no Net County Cost associated with this system of stroke care.