Regional access to acute ischemic stroke intervention

Background and Purpose-Benefit-risk ratios from recombinant tissue plasmino gen activator (rtPA) therapy for acute ischemic stroke demonstrate lack of efficacy if intravenous administration is commenced beyond 3 hours of sympt om onset. We undertook to enhance therapeutic effectiveness by ensuring equ itable access to rtPA for patients affected by acute ischemic stroke within a 20 000 km(2) population referral base served by a tertiary facility. Methods-Representatives of all provider groups involved in emergency medica l services developed a Regional Acute Stroke Protocol (RASP), a coordinated regional system response by dispatch personnel, paramedics, physicians, co mmunity service providers, emergency and inpatient staff in community hospi tals, and the tertiary facility acute stroke team. Results-As of July 26, 1999, all ambulance services in Southeastern Ontario began bypassing the closest hospital to deliver patients meeting the crite ria for the RASP to the Kingston General Hospital. At 12 months, approximat ely 403 ischemic strokes have occurred in the region, the RASP has been act ivated 191 times, and 42 patients have received rtPA. Conclusions-We conclude that (1) acute stroke patients in Southeastern Onta rio have improved access to interventions for stroke care; (2) geography of the region is not a barrier to access to interventions for patients with a cute stroke; and (3) acute ischemic stroke patients treated with rtPA accou nt for 5% of all acute strokes and 10% of all ischemic strokes in this regi on.