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Stroke

The brain, like any organ in the body, relies on oxygen to survive and function.  Oxygen is carried to the tissues of the body by blood.  A stroke or “cerebrovascular accident (CVA)” occurs when an interruption in blood flow to the brain causes the brain to be deprived of oxygen and there is resulting damage or death of brain tissues.  There are two types of stroke: (1) “hemorrhagic strokes” that occur due to bleeding in the brain from broken or damaged blood vessels and, (2) “ischemic strokes” that occur due to an obstruction within a blood vessel supplying blood to the brain. According to the American Stoke Association (ASA), “ischemic stroke” accounts for about 87% of all stroke cases (to view more information about strokes, please click here to visit the ASA webpage). This may happen if arteries supplying blood slowly narrow from a buildup of fat, cholesterol and other substances that together are called “plaque.” This slow process is known as “atherosclerosis.” If plaque in an artery breaks, a blood clot forms around the plaque. This blood clot can block the flow of blood to the brain. Sometimes, the interruption in blood flow is only temporary. When signs and symptoms of a stroke last less than 24 hours and resolve completely, the term used for the condition is “transient ischemic attack (TIA).” However, these so called “mini strokes” should be taken very seriously and immediately evaluated by a physician. A “mini stroke” is often a warning sign that a more serious stroke is likely to happen (to view more information about “mini-strokes,” please click here to visit the ASA webpage).
 
To better evaluate the effectiveness of pre-hospital patient care provided to stroke patients by FEMS first responders and Paramedics, the EMS Continuous Quality Improvement (CQI) office reviews patient cases treated and transported by FEMS personnel on a monthly basis. FEMS has established a goal of not less than 95% of patient cases reviewed indicating timely, appropriate and successful patient treatment. The FEMS KPI measure for this goal is the “percentage of patient cases reviewed indicating timely, appropriate and successful patient treatment.”
 
EMS CQI review focuses on three patient treatment elements for suspected stroke cases. These include: (1) if a stroke screening exam was successfully completed for the patient, (2) if a blood glucose level check was successfully completed and recorded for the patient and, (3) if the patient was transported to a Stroke Center hospital. Each of these elements contributes to effective patient treatment and must be completed by FEMS first responders and Paramedics when treating and transporting a suspected stroke patient.     
 
The table below shows the number of suspected stroke cases reviewed by the EMS CQI office, the count of required patient treatment elements completed by FEMS personnel, the percentage of required patient treatment elements completed by FEMS personnel and the overall completion rate for all required elements (combined):
 
FY 20-03A STROKE T-1 Image Q-4 (Website).png
 
The chart below shows the total count of suspected stroke cases with individual counts of required patient treatment elements completed by FEMS personnel (by month):
 
FY 20-03B STROKE-01 Image Q-4 (Website).png
 
The chart below shows the combined count of required patient treatment elements, with the combined counts and percentages of required patient treatment elements completed by FEMS personnel for suspected stroke cases (by month):
 
FY 20-03C STROKE-02 Image Q-4 (Website).png