Hospitals Offering Hyper – acute Stroke Services Time since onset Operational Hospital of symptoms/ Convey the Patient to: South & East Region Hours Location Age Limit 5 hrs 24/7 Heath Park University Hospital of Wales Emergency 18 – 80 yrs acute stroke Cardiff Department Cardiff & Vale University Health Board service CF14 4XN 24/7 Cardiff Road Royal Gwent Hospital 4.5 hrs Emergency acute stroke Newport 18 – 80 yrs Department Aneurin Bevan Health Board service NP9 2UB 9-5 Mon-Fri Abergavenny Nevill Hall Hospital 4.5 hrs Emergency Excluding Gwent 18 – 80 yrs Department Aneurin Bevan Health Board B/H NP7 7EG 9-5 Mon-Fri Ynys Maerdy Royal Glamorgan Hospital 4.5 hrs Emergency Excluding Llantrisant 18 – 80 yrs Department Cwm Taf Health Board B/H CF72 8XR Merthyr Tydfil 9-5 Mon-Fri Prince Charles Hospital 4.5 hrs Rhondda Emergency Excluding 18 – 80 yrs Cynon Taff Department Cwm Taf Health Board B/H CF47 9DT Time since onset Operational Hospital of symptoms/ Convey the Patient to: Central & West Region Hours Location Age Limit 24/7 Coity Road, Princess of Wales Hospital 3 hrs Emergency acute stroke Bridgend 18 – 80 yrs Department Abertawe Bro Morgannwg UHB service CF31 1RQ 24/7 Moriston University Hospital 3 hrs Swansea Emergency acute stroke 18 – 80 yrs SA6 6NL Department Abertawe Bro Morgannwg UHB service Caradog Road 24/7 Bronglais General Hospital 3 hrs Aberystwyth CT Scanner acute stroke 18 – 80 yrs Ceredigion Department Hywel Dda Health Board service SY23 1ER 24/7 Withybush General Hospital 3 hrs Pembrokeshire Emergency acute stroke 18 – 80 yrs SA61 2PZ Department Hywel Dda Health Board service 24/7 West Wales General Hospital 3 hrs Carmarthenshire Emergency acute stroke 18 – 80 yrs SA31 2AF Department Hywel Dda Health Board service 24/7 Prince Philip Hospital 3 hrs Carmarthenshire Emergency acute stroke 18 – 80 yrs SA14 8QF Department Hywel Dda Health Board service Hospitals Offering Hyper acute Stroke Services Working Together for Success K. Smith, Clinical Support Officer August 2011 V5 Time since onset Operational Hospital of symptoms/ Convey the Patient to: North Wales Region Hours Location Age Limit 9-5 Mon-Fri Ysbyty Gwynedd, Bangor Hospital 3 hrs Gwynedd Emergency Excluding 18 – 80 yrs LL57 2PW Department Betsi Cadwaladr UHB B/H 9-5 Mon-Fri Wrexham Maelor, Wrexham Hospital 3 hrs Wrexham Emergency Excluding 18 – 80 yrs LL13 7TD Department Betsi Cadwaladr UHB B/H 9-5 Mon-Fri Ysbyty Glan Clwyd Hospital 3 hrs Denbighshire Emergency Excluding 18 – 80 yrs LL18 5UJ Department Betsi Cadwaladr UHB B/H Time since onset Operational Hospital of symptoms/ Convey the Patient to: NHS England Hours Location Age Limit 24/7 6 hrs Chester Emergency acute stroke Countess of Chester Hospital 18 – 80 yrs CHL 1UL Department service 08:00 20:00 3 hrs Mon-Fri Shrewsbury Emergency Royal Shrewsbury Hospital 18 – 80 yrs Excluding SY3 8XQ Department B/H 24/7 3 hrs Hereford Emergency acute stroke Hereford County Hospital 18 – 80 yrs HR1 2ER Department service TIME IS BRAIN – Acute Strokes (CVAs) and Transient Ischaemic Attacks (TIAs) are to be treated as an EMERGENCY. Please prioritise all Stroke Patients at all times, who fulfil the criteria for Fast Tracking, to participating hospitals but do not build false expectations around thrombolysis for Stroke patients, the decision for thrombolysis is Stroke Consultant led. When patients are on the edge of a Hospital’s ‘catchment’ area, act in the patient’s best interest. However consider the impact of the journey time from onset of symptoms to arriving in hospital, also if appropriate consider the air ambulance for conveyance. Confirm hospital criteria for onset of symptoms time. It is important to remember that thrombolysis is not the only management proven to benefit stroke patients. Admission to a stroke unit for early specialist care is known to be life saving and to reduce disability, even if thrombolysis is not indicated. The European license limit for thrombolysis in acute stroke is 3hrs for patients aged 18-80 years. Thrombolysis can only be administered following a CT brain scan (to exclude bleed) and following assessment by a specialist stroke doctor. However some Health Board stroke services within Wales are involved in clinical trials, e.g. International Stroke Trial 3 where thrombolysis is randomised and can be given up to six hours from the onset of symptoms and to patients aged >80 yrs. Stroke services are constantly being reviewed , please check the Trust`s Intranet for the latest revision of this document (Support services – Clinical Effectiveness – Referral Pathways Hospitals Offering Hyper acute Stroke Services Working Together for Success K. Smith, Clinical Support Officer August 2011 V5 Pre-Hospital Management of Stroke: Assess Airway, Breathing, Circulation, Disability and FAST test Transport the Conscious Stroke patient in the semi-recumbent position An informant should be encouraged to accompany the patient. All medication should be brought with the patient. Administer oxygen only when necessary (target saturation range 94%-98%) Patients should be nil by mouth Blood glucose level should be measured and if <4mmols/litre, 100ml 10% glucose by slow IV infusion. In all cases, administration of IV glucose should be titrated against effect. If IV glucose cannot be administered, glucagon may be administered via the IM route. Repeat Face, Arm and Speech Test (FAST) / ROSIER Actively manage hypotension by giving saline and/or raising the foot of the ambulance trolley Consider recording 12-lead ECG (Emergency Medical Technician to record 3 lead) en route to hospital, but do not delay transport for this test Record Blood Pressure Pupil size and reaction to light History of event, including time of onset, signs and symptoms and previous medical, drug and social history, should be taken from the patient and/or informant. DO NOT administer aspirin if a stroke is suspected The ASHICE message must contain the following information. Age / Name and D.O.B . Sex . History . Injuries . Condition – pulse, BP, GCS, and AVPU . ETA – estimated time of arrival . FAST / ROSIER positive Should you have any queries regarding this care pathway please contact a Clinical Support Officer, Station Supervisor, Clinical Team Leader or Practitioner Educator for advice. Alternatively e-mail your queries to [email protected] Useful link Stroke Training and Awareness Resources at www.strokecorecompetencies.org Hospitals Offering Hyper acute Stroke Services Working Together for Success K. Smith, Clinical Support Officer August 2011 V5 Hyper Acute Stroke – Pre-Hospital pathway – “Time is Brain” 999/GP CALL Possible Stroke / TIA Patient FAST Test Does the patient have at least one of the following acute signs? Obvious Facial Droop Unilateral Arm / Leg Weakness Abnormal Speech NO SUSPECTED STROKE / TIA? YES NO Is the patient free from seizures/fits since onset? Treat Hypoglycaemia in YES accordance with latest clinical guidelines. NO Note: If symptoms Is BM > 4 mmols/l persist with BM> 4mmols/l then YES treat as Stroke. NO Are acute stroke services available? (check hospital operational hours) YES NO Is the patient likely to arrive while thrombolysis option available? Convey the Patient to the (check time since onset of symptoms) appropriate Hospital PASS Hospital Pre-alert Transport as YES (ASHICE) message plus per Normal add Phrase Clinical “Alert Stroke Team” Practice/ Guidelines NB: document FAST test on PCR Hospitals Offering Hyper acute Stroke Services Working Together for Success K. Smith, Clinical Support Officer August 2011 V5 .