hb-1145 and lvo scales€¦ · hb-1145 and lvo scales sara brown, md facep parkview regional ems...
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HB-1145 and LVO ScalesSara Brown, MD FACEP
Parkview Regional EMS Medical Director
Board Certified EMS Physician
Indiana EMS Commission
CDC Stroke Death Rates
https://www.in.gov/isdh/27347.htm
CDC Stroke Death Rates
https://www.in.gov/isdh/27347.htm
Indiana HB-1145
Indiana State Department of Health
• list of certified hospitals
• list of Indiana network participating hospitals
Indiana State Department of Homeland Security
• EMS Commission
• EMS Protocols
• Stroke assessment tool
EMS Commission
EMS Commission Stroke Workgroup
•EMS Commission Members
•American Stroke Association
• Indiana Hospital Association
• Indiana Stroke Consortium of Indiana
• Indiana Department of Health
S
• Stroke Ready Hospitals → 1
• Primary Stroke Centers → 36
• Comprehensive Stroke Center → 1
Indiana Stroke Hospitals
EMS Commission Rule Draft
Indiana State Department of Health
• list of certified hospitals
• list of Indiana network participating hospitals
HB-1145
•Certified Stroke Hospitals• Provide ISDH with copies of certification and dates
• Notify ISDH not more than 48 hours after change
“Indiana network participating hospitals”
HB-1145
•Network participating hospital• Must provide ISDH with a copy of the written transfer agreement
LVO Screening Tools
LVO Process
Recognize symptoms
Call 911; Dispatch Screen
EMS Assessment and transport
ER / CT / TPA?
Transfer to intervention
center
CTA/CTP
Intervention
LVO Screening Tools
NIH LAMS RACE
CSTAT FAST-ED
NIH / Heidner 2016
• Anterior Circulation Strokes only
• Cut-off > 7
• Sensitivity 81.0 %
• Specificity 76.6 %
• Best sub-items• Best gaze
• Visual fields
• Motor arms
• Aphasia / neglect
J Neurol. 2016 Aug;263(8):1633-40. doi: 10.1007/s00415-016-8180-6. Epub 2016 Jun 6.
RACE
• 6 items
• Sensitivity 55%
• Specificity 87%
LAMS
• 3 tests
• Sensitivity 66%
• Specificity 86%
CSTAT
• 3 tests
• Sensitivity 56%
• Specificity 85%
FAST-ED
• 5 tests
• Sensitivity 71%
• Specificity 78%
Stroke. 2016 August ; 47(8): 1997–2002. doi:10.1161/STROKEAHA.116.013301.
Questions?