Incorporating Nonphysician Stroke Specialists Into the Stroke Team.

Abstract

Stroke care is team-based care, but trainees in neurology programs may have little experience in working directly with stroke specialists from other disciplines. Outside of an intensive care unit, nurses and physicians rarely round as a team, and stroke neurologists often have few interactions with prehospital care providers besides a quick handoff in the emergency room. However, nonphysician stroke specialists bring a broad base of expertise which overlaps with and complements the stroke neurologist’s knowledge. Increasingly, integrated stroke care is being provided by multidisciplinary teams. Team structures may vary from hospital to hospital and country to country, but often include integration of emergency medical services (EMS; particularly where mobile stroke treatment units are used); specialized nurses and nurse practitioners (NPs); and specialized therapy teams including speech and language pathologists, occupational therapists, and physical therapists with particular expertise in poststroke care. The stroke chain of survival begins with the 911 call, yet even high-level paramedics receive little formal stroke training outside of standard Advanced Cardiac Life Support protocols. EMS providers are often the first point of contact for the stroke patient and have the opportunity to collect vital information about timing of symptoms and medication use. First responders to stroke 911 calls may be Basic Life Support or Advanced Cardiac Life Support level. EMS providers should be familiar with validated prehospital stroke scales such as the Cincinnati Prehospital Stroke Scale.1 EMS providers who have more experience with stroke, such as paramedics who staff mobile stroke treatment units, find stroke to be an exciting field because of the time-critical nature of the treatment. Therefore, it is imperative that stroke neurologists reach out to EMS providers to offer additional training in stroke care. A basic understanding of stroke syndromes is both fascinating and extremely useful to EMS providers, who are often eager …