This Article Full Text Full Text (PDF) 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 Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Riopelle, R.J. Articles by Weaver, D.F. Search for Related Content PubMed PubMed Citation Articles by Riopelle, R.J. Articles by Weaver, D.F. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Stroke Related Collections Acute Cerebral Infarction Emergency treatment of Stroke Thrombolysis

(Stroke. 2001;32:652.)
© 2001 American Heart Association, Inc.

Original Contributions

Regional Access to Acute Ischemic Stroke Intervention

R.J. Riopelle, MD; D.C. Howse, MD; C. Bolton, MBA; S. Elson, MA; D.L. Groll, MSc; D. Holtom, ACNP; D.G. Brunet, MD; A.C. Jackson, MD; M. Melanson, MD D.F. Weaver, MD

From Queen’s University Care Delivery Network Project (R.J.R., C.B., S.E., D.L.G.), and Division of Neurology (R.J.R., D.C.H., D.G.B., A.C.J., M.M., D.F.W.), and the Department of Nursing (D.H.), Kingston General Hospital, Kingston, Canada.

Correspondence to R.J. Riopelle, MD, FRCP(C), Director, Queen’s University Care Delivery Network Project, c/o Kingston General Hospital, Kingston, ON, K7L 2V7 Canada. E-mail riopelle{at}post.queensu.ca

Background and Purpose—Benefit-risk ratios from recombinant tissue plasminogen activator (rtPA) therapy for acute ischemic stroke demonstrate lack of efficacy if intravenous administration is commenced beyond 3 hours of symptom onset. We undertook to enhance therapeutic effectiveness by ensuring equitable access to rtPA for patients affected by acute ischemic stroke within a 20 000 km² population referral base served by a tertiary facility.

Methods—Representatives of all provider groups involved in emergency medical services developed a Regional Acute Stroke Protocol (RASP), a coordinated regional system response by dispatch personnel, paramedics, physicians, community service providers, emergency and inpatient staff in community hospitals, 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 criteria for the RASP to the Kingston General Hospital. At 12 months, approximately 403 ischemic strokes have occurred in the region, the RASP has been activated 191 times, and 42 patients have received rtPA.

Conclusions—We conclude that (1) acute stroke patients in Southeastern Ontario have improved access to interventions for stroke care; (2) geography of the region is not a barrier to access to interventions for patients with acute stroke; and (3) acute ischemic stroke patients treated with rtPA account for 5% of all acute strokes and 10% of all ischemic strokes in this region.

Key Words: health services accessibility • stroke, acute • stroke, ischemic

This article has been cited by other articles:

				P. Lindsay RN PhD, M. Bayley MD, A. McDonald BScPT, I. D. Graham PhD, G. Warner PhD, and S. Phillips MBBS Toward a more effective approach to stroke: Canadian Best Practice Recommendations for Stroke Care Can. Med. Assoc. J., May 20, 2008; 178(11): 1418 - 1425. [Abstract] [Full Text] [PDF]

				J. E. Acker III, A. M. Pancioli, T. J. Crocco, M. K. Eckstein, E. C. Jauch, H. Larrabee, N. M. Meltzer, W. C. Mergendahl, J. W. Munn, S. M. Prentiss, et al. Implementation Strategies for Emergency Medical Services Within Stroke Systems of Care: A Policy Statement From the American Heart Association/ American Stroke Association Expert Panel on Emergency Medical Services Systems and the Stroke Council Stroke, November 1, 2007; 38(11): 3097 - 3115. [Full Text] [PDF]

				Part 4: Adult Basic Life Support Circulation, December 13, 2005; 112(24_suppl): IV-19 - IV-34. [Full Text] [PDF]

				Part 9: Adult Stroke Circulation, December 13, 2005; 112(24_suppl): IV-111 - IV-120. [Full Text] [PDF]

				Part 9: Stroke Circulation, November 29, 2005; 112(22_suppl): III-110 - III-104. [Full Text] [PDF]

				M. J. Alberts, R. E. Latchaw, W. R. Selman, T. Shephard, M. N. Hadley, L. M. Brass, W. Koroshetz, J. R. Marler, J. Booss, R. D. Zorowitz, et al. Recommendations for Comprehensive Stroke Centers: A Consensus Statement From the Brain Attack Coalition Stroke, July 1, 2005; 36(7): 1597 - 1616. [Abstract] [Full Text] [PDF]

				N U Weir and A M Buchan A study of the workload and effectiveness of a comprehensive acute stroke service J. Neurol. Neurosurg. Psychiatry, June 1, 2005; 76(6): 863 - 865. [Abstract] [Full Text] [PDF]

				V. C. Douglas, D. C. Tong, L. A. Gillum, S. Zhao, L. M. Brass, J. Dostal, and S. C. Johnston Do the Brain Attack Coalition's criteria for stroke centers improve care for ischemic stroke? Neurology, February 8, 2005; 64(3): 422 - 427. [Abstract] [Full Text] [PDF]

				J. Kwan, P. Hand, and P. Sandercock Improving the efficiency of delivery of thrombolysis for acute stroke: a systematic review QJM, May 1, 2004; 97(5): 273 - 279. [Abstract] [Full Text] [PDF]

				S. L. Silliman, B. Quinn, V. Huggett, and J. G. Merino Use of a Field-to-Stroke Center Helicopter Transport Program to Extend Thrombolytic Therapy to Rural Residents Stroke, March 1, 2003; 34(3): 729 - 733. [Abstract] [Full Text] [PDF]

				H. J. Cloft, T. A. Tomsick, D. F. Kallmes, J. H. Goldstein, and J. J. Connors Assessment of the Interventional Neuroradiology Workforce in the United States: A Review of the Existing Data AJNR Am. J. Neuroradiol., November 1, 2002; 23(10): 1700 - 1705. [Full Text] [PDF]

				J. A. Chalela, I. Katzan, D. S. Liebeskind, P. Rasmussen, O. Zaidat, J. I. Suarez, D. Chiu, R. P. Klucznick, E. Jauch, B. L. Cucchiara, et al. Safety of Intra-Arterial Thrombolysis in the Postoperative Period Editorial Comment : Safety of Intra-Arterial Thrombolysis in the Postoperative Period Stroke, June 1, 2001; 32(6): 1365 - 1369. [Abstract] [Full Text] [PDF]