This Article Full Text Full Text (PDF) All Versions of this Article: 39/4/1246    most recent STROKEAHA.107.500678v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Demaerschalk, B. M. Articles by Paulsen, M. PubMed PubMed Citation Articles by Demaerschalk, B. M. Articles by Paulsen, M. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Emergency Medical Services Stroke Related Collections Thrombolysis Acute Cerebral Infarction Emergency treatment of Stroke

(Stroke. 2008;39:1246.)
© 2008 American Heart Association, Inc.

Original Contributions

Development of a Metropolitan Matrix of Primary Stroke Centers

The Phoenix Experience

From the Departments of Neurology (B.M.D.) and Emergency Medicine (B.J.B.), Mayo Clinic, Scottsdale, Ariz; and the Halle Heart Center (M.P.), Tempe, Ariz.

Correspondence to Bart M. Demaerschalk, MD, MSc, FRCP(C), Department of Neurology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259. E-mail demaerschalk.bart{at}mayo.edu

Background and Purpose— In 1998, 2947 patients in metropolitan Phoenix were hospitalized for acute cerebral infarction. Only 2 of the 26 regional hospitals satisfied criteria for primary stroke center (PSC) designation. Fewer than 1% of patients with ischemic stroke received tissue plasminogen activator for thrombolysis. We sought to develop and evaluate the effectiveness of a metropolitan prehospital emergency medical system for effectively identifying and transporting patients with acute stroke to a matrix of predesignated PSCs and increasing to 20% the proportion of all such patients receiving tissue plasminogen activator.

Methods— The American Stroke Association Phoenix Operation Stroke partnered with the Arizona Emergency Medical Systems in 1998 to 1999 to list goals and objectives, identify key stakeholders, and develop committees to address community education, emergency medical system training, and PSC designation.

Results— Over 8 years, emergency medical system personnel were trained to identify and transport patients with acute stroke to PSCs, 8 hospitals met PSC criteria, the metropolitan matrix of PSCs became operational (in 2003), and 18% of patients with acute ischemic stroke received thrombolysis.

Conclusions— It is feasible to develop and operationalize a successful metropolitan-wide matrix of PSCs to accommodate emergency medical system-identified and transported patients with acute stroke in a 9000-square-mile region with a population of 3.5 million people.

Key Words: acute stroke • community health services • education • emergency medical systems • paramedic • primary stroke center • thrombolytic therapy • tissue plasminogen activator