ENSURING THE CHAIN OF RECOVERY FOR STROKE IN YOUR COMMUNITY

Until recently, the prehospital and ED management of nonhemorrhagic st roke was largely supportive care, Studies have now demonstrated the po tential of certain therapeutic interventions to reverse the debilitati ng consequences of such strokes, The clinical benefit for such interve ntions and the risk of significant therapeutic complications are highl y time-dependent, To optimize the chances of a better outcome fan, the patient with stroke, each community must establish and continue to re fine a chain of recovery for stroke patients, The chain of recovery is a metaphor that describes a series of sequential actions that must ta ke place in a timely fashion to optimize the chances of recovery from stroke, Each of these sequential actions forms an individual link in t he chain, and each link must be intact. The links include: identificat ion of the onset of stroke symptoms by the patient or bystanders; disp atch life support services, which preferably include enhanced 9-1-1 an d medically supervised and trained dispatchers who can rapidly deploy the closest responders and transport units; emergency medical services (EMS) personnel who can rapidly assess and transport the stroke patie nt to the closest appropriate center capable of providing advanced str oke diagnostics and interventions; en route notification of the receiv ing facility so that appropriate personnel can be readied for rapid di agnosis and intervention; and receiving facilities capable of providin g rapid diagnosis and advanced treatment of stroke, including the avai lability of specialists who can evaluate underlying etiologies as well as plan future therapies and rehabilitation. To ensure that the chain of recovery is in place, aggressive public education campaigns should be implemented to increase the probability that stroke symptoms and s igns will be recognized as soon as possible by patients and bystanders , In addition, because most of the current training programs for EMS d ispatchers and EMS personnel are lacking with regard to stroke, it is recommended that such personnel and their EMS system managers be updat ed on current management and treatment strategies for stroke.