NYS 2015 Stroke Reporting education review

1. EMS Stroke
Reporting
Initiative
New York State Department
of Health

2. Introduction
Starting in 2015, New York State is going to
require that Stroke Centers record and report
on new data points that include information
regarding the pre-hospital recognition,
treatment and hospital notification. This
information will be utilized to improve quality of
stroke care. The following slides will provide
education on the required data points, the pre-hospital
role in gathering this data and to
reinforce previous knowledge on pre-hospital
stroke assessments.

3. What’s being tracked?
As previously noted, the DOH will start requiring stroke centers in
New York State to collect and report on 5 key data points. The
first four points are EMS specific actions. The data points are as
follows:
 Did EMS perform the Cincinnati Pre-Hospital Stroke Assessment
as outlined in State EMS Protocol?
 Did EMS establish an onset of signs/symptoms?
 Did EMS notify the receiving hospital prior to arrival at the
hospital of the findings of #1 & #2 and that Stroke is suspected?
 Was a PCR showing the pre-hospital assessment, findings, and
treatment of a stroke provided to the hospital upon patient
arrival?
 Did the hospital activate its Stroke Team/Protocol based on the
information from EMS, or wait until after the patient was in the
ED?

4. Cincinnati Stroke Assessment
Although many providers have learned more in-depth
and detailed stroke assessments, NYS still
requires a stroke alert to be based on the
Cincinnati Pre-Hospital Stroke Assessment at a
minimum. It is not the recommendation of
Clifton Park & Halfmoon Emergency Corps to
limit your assessment of a stroke patient to only
the Cincinnati Pre-Hospital Stroke Assessment,
but merely to indicate what specific guidelines
the state is looking for in this current initiative.

6. Cincinnati Stroke Assessment
As noted in the previous slide, the Cincinnati
Pre-Hospital Stroke Assessment focuses on 1)
Facial Droop 2) Arm Drift and 3) Abnormal
Speech. When reporting your findings,
please remember to report on each of
these three data points at a minimum when
activating a stroke alert. Your PCR can
include other assessment points as you
deem appropriate.

7. Time of Onset
For a thrombolytic stroke, many NYS Stroke centers
utilize a 3 to 4.5 hour treatment window from the initial
onset of signs/symptoms as a guideline; although other
treatment windows do exist. As this is a relatively small
window, it is important for EMS to establish an accurate
onset of signs/symptoms and report this information to
the receiving hospital in the pre-arrival report. Asking
appropriate questions from witnesses and family
members is of great importance, and it is additionally
recommended that a witness of the neurological event
if possible be brought with the patient to the hospital. It
is important to note that if a patient wakes up with
symptoms, "Time Zero" is considered the last time that
the patient was seen acting normal prior to waking up.

8. Pre Arrival “Stroke Alert”
Data point three tracks if EMS provides the
information gathered from Data Point 1 (Cincinnati
Pre-Hospital Stroke Assessment) and Data Point 2
(Established time of signs/symptom onset) to the
hospital in a specific pre-arrival “stroke alert”
report. This can been accomplished either by a
radio report or by establishing a signal on the REMO
recorded line when calling for any additional orders.
It is encouraged to provide this report as soon as
possible, possibly before leaving the scene if
appropriate. For your documentation, it is important
to note the specific time you performed the pre-arrival
report and the method you performed it by.

9. CPHM Short Form
Data point 4 is tracking if EMS provided the
hospital a written report upon patient arrival
that included the pre-hospital assessment,
findings, and treatment of a stroke. This
requirement will be met by utilizing an
updated short form from our agency that
will have a specific area dedicated for
stroke patients. Crew members will be
required to obtain a signature from the RN
receiving the written report.

11. Stroke Protocol Activation
The final data point tracks if the receiving
hospital activated its Stroke Team/Protocol
based on the information from EMS, or did
they wait until after the patient was in the
ED. This is not a piece of information we will
have input on or any interaction with.

12. Inter-Agency Tracking
To verify that CPHM EMS is meeting the
goals of the data points being tracked, the
QA/QI process will adapt to verify that any
patient meeting the stroke protocol will
have these data points addressed during
our care and in our documentation.
Our goal, and belief is that this agency will
continue to meet and exceed these goals
to help demonstrate our skill and thorough,
quality care.