Hospitals Offering Hyper–acute Stroke Services Time since onset Operational Hospital of symptoms/ Convey the Patient to: South & East Region Hours Location Age Limit 24/7 Heath Park University Hospital of Wales 4.5 hrs Emergency acute stroke Cardiff 18 years or over Department Cardiff & Vale University Health Board service CF14 4XN 24/7 Cardiff Road Royal Gwent Hospital 4.5 hrs Emergency acute stroke Newport 18 years or over Department Aneurin Bevan Health Board service NP9 2UB 9-5 Mon-Fri Abergavenny Nevill Hall Hospital 4.5 hrs Emergency Excluding Gwent 18 years or over Department Aneurin Bevan Health Board B/H NP7 7EG Merthyr Tydfil 24/7 Emergency Prince Charles Hospital Rhondda 18 years or over acute stroke Department Cynon Taff Cwm Taf Health Board service 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 4.5 hrs Emergency acute stroke Bridgend 18 years or over Department Abertawe Bro Morgannwg UHB service CF31 1RQ 24/7 Moriston University Hospital 4.5 hrs Swansea Emergency acute stroke 18 years or over SA6 6NL Department Abertawe Bro Morgannwg UHB service Caradog Road 24/7 Bronglais General Hospital 4.5 hrs Aberystwyth CT Scanner acute stroke 18 years or over Ceredigion Department Hywel Dda Health Board service SY23 1ER 24/7 Withybush General Hospital 4.5 hrs Pembrokeshire Emergency acute stroke 18 years or over SA61 2PZ Department Hywel Dda Health Board service 24/7 West Wales General Hospital 4.5 hrs Carmarthenshire Emergency acute stroke 18 years or over SA31 2AF Department Hywel Dda Health Board service 24/7 Prince Philip Hospital 4.5 hrs Carmarthenshire Emergency acute stroke 18 years or over SA14 8QF Department Hywel Dda Health Board service Hospitals Offering Hyper-Acute Stroke Services Working Together for Success Medical and Clinical Services Directorate K. Smith, April 2015 V8 Time since onset Operational Hospital of symptoms/ Convey the Patient to: North Wales Region Hours Location Age Limit 24/7 Ysbyty Gwynedd, Bangor Hospital 4.5 hrs Gwynedd Emergency acute stroke 18 years or over LL57 2PW Department Betsi Cadwaladr UHB service 24/7 Wrexham Maelor, Wrexham Hospital 4.5 hrs Wrexham Emergency acute stroke 18 years or over LL13 7TD Department Betsi Cadwaladr UHB service 24/7 Ysbyty Glan Clwyd Hospital 4.5 hrs Denbighshire Emergency acute stroke 18 years or over LL18 5UJ Department Betsi Cadwaladr UHB service 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 years or over CHL 1UL Department service 24/7 4.5 hrs Shropshire Emergency acute stroke Princess Royal Hospital Telford 18 years or over TF1 6TF Department service 24/7 4.5 hrs Hereford Emergency acute stroke Hereford County Hospital 18 years or over HR1 2ER Department service TIME IS BRAIN – Acute Strokes (CVAs) and Transient Ischaemic Attacks (TIAs) are to be treated as an EMERGENCY. Every minute a stroke goes untreated 1.9 million brain cells are lost so any delay in presentation to medical care, however short, leads to significant loss of brain function. 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. Stroke services are constantly being reviewed, please check the Trust’s Intranet for the latest version of this document: Support services – Clinical Effectiveness – CE Related Documents and Links Hospitals Offering Hyper-Acute Stroke Services Working Together for Success Medical and Clinical Services Directorate K. Smith, April 2015 V8 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 Exclude hypoglycemia as the cause of sudden-onset neurological symptoms. 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) 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 Patient Temperature NEWS score 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 / include time of onset . Injuries . Condition – BM, BP, GCS, NEWS and AVPU . ETA – estimated time of arrival . FAST positive Should you have any queries regarding this care pathway please contact a Clinical Team Leader for advice. Alternatively e-mail your queries to [email protected] [email protected] Useful link for Stroke Training and Awareness Resources at: www.strokecorecompetencies.org Hospitals Offering Hyper-Acute Stroke Services Working Together for Success Medical and Clinical Services Directorate K. Smith, April 2015 V8 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 Is BM > 4 mmols/l Note: If symptoms persist with BM> 4mmols/l then YES Treat as Stroke. Are acute stroke services available? NO (Check hospital operational hours) YES NO Is the patient likely to arrive while Convey the Patient to the thrombolysis option available? appropriate Hospital (Check time since onset of symptoms) PASS Hospital Pre-alert (ASHICE) message plus Transport as add Phrase per Normal YES “Alert Stroke Team” Clinical Practice/ NB: document FAST test Guidelines on PCR Hospitals Offering Hyper-Acute Stroke Services Working Together for Success Medical and Clinical Services Directorate K. Smith, April 2015 V8 .