The Dallas Area Stroke Network, a voluntary collaboration between hospitals and the Dallas Emergency Medical Service (EMS), is dedicated to providing the community with a more timely response to stroke. Physicians on the medical staffs at participating hospitals are available to treat appropriate patients with clot-dissolving drugs. The program is part of the American Stroke Association initiative “Operation Stroke,” a three-year-old national program created to mobilize communities to strengthen stroke awareness and optimize treatment availability.

Operation Stroke has four specific objectives:
• Educate the general public about the warning signs of stroke.
• Encourage the general public to call 911 when these warning signs are experienced by themselves or someone around them.
• Urge EMS systems to upgrade the coding for transport of stroke patients, to train EMS personnel to assess for stroke, to train medical dispatchers, and to implement EMS outcomes-tracking systems.
• Urge acute care medical facilities to implement stroke protocols, stroke teams, and stroke units and to implement medical facility outcomes-tracking systems.

To accomplish these objectives will require adherence to the “Stroke Chain of Survival”—a four-part process that spreads the responsibility for timely stroke treatment among patients, emergency response units, and physicians. The links in the chain include:
• Rapid recognition and reaction to stroke warning signs.
• Rapid start of prehospital care.
• Rapid EMS system transport and hospital prenotification.
• Rapid diagnosis and treatment at the hospital.

FORGING THE CHAIN OF SURVIVAL

In Dallas, Operation Stroke is being coordinated through Biotel—an EMS triage agency—which has developed an on-call rotation system through the Dallas EMS. “The service targets those persons with early symptoms of stroke and is limited to individuals who are evaluated by the Dallas EMS within 3.5 hours of onset of symptoms,” said Paul E. Pepe, MD, MPH, the Dallas EMS director. “Persons who receive evaluation by EMS personnel within the recommended time frame are given three options when they are transported: to be taken to one of the stroke service facilities, to the hospital of their choice, or to the closest hospital. Therefore, from the patient’s perspective, participation is strictly voluntary,” he explained. Dr. Pepe, Professor and Chairman of the Division of Emergency Medicine at the University of Texas Southwestern Medical Center at Dallas, added that the on-call rotation among the stroke service facilities has been in place since August 2002 and has demonstrated success in rapidly transporting patients with early symptoms of stroke to the nearest participating hospital.

The invitation to participate in the Dallas Area Stroke Network is open to all Dallas hospitals. Stroke service facilities participating to date are Baylor University Medical Center, Parkland Health and Hospital System, Presbyterian Hospital of Dallas, and Richardson Regional Medical Center.

OPERATION STROKE—TEXAS STYLE

With the formation of the stroke network, Dallas joins more than 125 other US cities participating in Operation Stroke. “The Dallas Area Stroke Network was designed to fulfill the goals of Operation Stroke and to hopefully give more patients in the metroplex the opportunity to receive expert care and treatment,” said neurologist Richard Hinton, MD, Chairperson for Operation Stroke and the Dallas Area Stroke Network. “It is also important to understand that not all stroke patients are suitable candidates for clot-dissolving drugs and the decision to treat or not to treat is based on complex issues. The purpose of the network is to have these decisions made by physicians who are experienced and knowledgeable in stroke,” Dr. Hinton added.

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Suggested Reading
Adams HP Jr, Adams RJ, Brott T, et al. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003;34:1056-1083.
Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation. 2002;106:388-391.
Schneider AT, Pancioli AM, Khoury JC, et al. Trends in community knowledge of warning signs and risk factors for stroke. JAMA. 2003;289:343-346.

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