What is the importance of early recognition in Advanced Stroke Life Support?

Every 40 seconds, someone in the United States suffers a stroke; every four minutes, one dies. Having the skills to administer emergency care in this "golden window" can significantly improve patient survivability and prognosis. Developed by The Gordon Center, the Advanced Stroke Life Support (ASLS) curriculum is used in hundreds of hospitals, fire rescue, ambulance and EMS systems, and educational institutions worldwide.

The ASLS course is designed to teach emergency medical services personnel (EMS) how to quickly and accurately assess stroke victims so they can be transported to a stroke center and begin treatment as soon as possible. The goal is to reduce death and disability by providing early treatment to patients with ischemic stroke, hemorrhagic stroke, or TIA (transient ischemic attack).

This training is critical to achieving the national goals of decreasing morbidity and mortality from stroke. It is a vital component of the stroke "chain of survival" - the five steps that can dramatically improve patient outcomes: early recognition; rapid and appropriate transport to the hospital; early diagnosis; prompt revascularization; and a well-organized follow-up program.

Early recognition involves identifying patients who have a high probability of having a stroke and distinguishing them from stroke mimics. This is an essential part of the process that starts with prehospital assessment by paramedics and continues when a stroke patient arrives in the hospital's ED. ED nurses and physicians are the next healthcare professionals that stroke patients encounter, and many studies have identified barriers to their timely and guideline-consistent implementation of a prompt, multifactorial, patient-oriented stroke assessment.

These barriers can range from inadequate knowledge of stroke (e.g., stroke screening tools, NIHSS) and a lack of time to complete the assessment to a low level of confidence in making a diagnosis of stroke. The EMS community is working hard to address these barriers through education programs, quality improvement initiatives, and the development of computer-based decision support systems (CDSS) to enhance clinical practice.

Despite these challenges, the early identification of stroke has been shown to improve stroke care, resulting in better outcomes for patients with ischemic stroke and intracerebral hemorrhage. Further study of methods to identify patients at a higher risk for stroke and to characterize their type is important to enable more efficient use of limited resources in the hospital.

To address these issues, the ASLS curriculum was revised in 2015 to include a focus on early recognition and characterisation of stroke. This includes teaching EMS personnel to conduct a neurological assessment and documenting a baseline mental status prior to transport, as well as recommending the immediate use of noncontrast CT scan for all stroke patients. These measures are critical for optimizing stroke care, particularly in the era of new therapies and interventions that may be more effective than previously available for treating acute stroke. Moreover, they are also relevant for other conditions that EMS and ED personnel often treat such as chest pain, heart attacks, and pneumonia.