Timeless Relevance

In re-reading Dr. Jeff Clawson’s article “BRAIN ATTACK! Why a HOT Response for STROKE Victims is Generally Not Indicated,” from 1996 (Yes, that’s nearly 30 years ago!), I was struck by its seemingly timeless relevance. In fact, response assignment questions regarding Protocol 28: Stroke (CVA/Transient Ischemic Attack (TIA)) remain common today, likely because treatment therapies and their related time windows have evolved significantly.

However, the message conveyed in Dr. Clawson’s 1996 article still holds true: Unless the suspected stroke patient is not alert or has airway or breathing problems, they are not likely to benefit from a lights-and-siren response that generally saves only a very few minutes at best.¹ And we know even more about the risk-benefit ratio of HOT responses than we anecdotally knew at that time.² We have evolved into an era that no longer bases performance primarily on response times, but rather key performance indicators that better reflect improved patient outcomes and system performance.³

It may be argued that modern-day stroke therapies have effectively decreased any need for lights-and-siren response as treatment time windows have expanded and pre-arrival and pre-hospital stroke diagnostic tools and notifications have evolved significantly. Rather than rapid response and transport of stroke patients to the nearest hospital to await diagnosis and CT scanner availability, and perhaps even additional transport to a stroke-treatment-capable hospital, stroke screening has evolved to reliably identify stroke patients, and even discern the type of stroke involved, so that appropriate hospitals can be pre-alerted and ready to definitively diagnose and treat these patients immediately upon arrival.

Additionally, pre-arrival stroke screening at dispatch has enabled the ability to compare stroke screening results and uncover any changes in patient condition. Formal recommendations and guidelines are now focusing on stroke systems of care that enable provider collaboration to ensure optimal outcomes.⁴

We are living in a time of rapidly evolving stroke identification and therapy. As with so many other medical maladies and traumatic conditions, Dispatch Life Support is evolving to meet these new challenges. No longer are we focusing on time as our primary outcome measure. As was so timelessly stated back in 1993 by Thera Bradshaw, past-president of the National Emergency Number Association, “It’s time we start doing it right, not just fast.”

Sources 
1. Sinclair R., Marler J. “Using EMD for Acute Stoke Identification.” Journal of the National Academy of EMD. 1998; 9. 
2. Kupas D.F., Zavadsky M., Burton B., Baird S., Clawson J.J., Decker C., Dworsky P., Evans B., Finger D., Goodloe J.M., LaCroix B., Ludwig G.G., McEvoy M., Tan D.K., Thornton K.L., Smith K., Wilson B.R. “Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses.” 2022; Feb. 14. NAEMSP. naemsp.org/wp-content/uploads/2023/10/Joint-Statement-on-Red-Light-and-Siren-Operations-with-Logos-FINAL-003.pdf (accessed Feb. 19, 2025). 
3. Kupas D.F., Zavadsky M., Burton B., Decker C., Dunne R., Dworsky P., Ferron R., Gerard D., Grover J., House J., Jarvis J., Murphy S., Overton J., Redlener M., Solomon G.W., Stephen A., Strozyk R., Trimble M., Wieczorek T., Wire K. “Joint Position Statement on EMS Performance Measures Beyond Response Times.” 2024; Oct. 1. Prehospital Emergency Care. Taylor & Francis Online. https://www.tandfonline.com/doi/full/10.1080/10903127.2024.2375739 (accessed Feb. 19, 2025). 
4. Task Force Members, Schwamm L.H., Pancioli A., Acker J.E., Goldstein L.B., Zorowitz R.D., Shephard T.J., Moyer P., Gorman M., Johnston S.C., Duncan P.W., Gorelick P., Frank J., Stranne S.K., Smith R., Federspiel W., Horton K.B., Magnis E., Adams R.J. “Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association’s Task Force on the Development of Stroke Systems.” 2005; Feb. 2. Stroke. AHA|ASA Journals. https://www.ahajournals.org/doi/full/10.1161/01.STR.0000158165.42884.4F (accessed Feb. 19, 2025).