The Brain Attack Coalition's recommendations for a Primary
Stroke Center address the following 11 major aspects of
acute stroke care:
Acute Stroke Teams
The Acute Stroke Team should include a physician with
experience in diagnosing and treating cerebrovascular
disease, and one other healthcare provider as a minimum.
Hospital-based stroke teams should be available around-the-
clock, seven days a week in order to evaluate within 15
minutes any patient who may have suffered a stroke.
Written Care Protocols
Hospitals should have written procedures to streamline and
accelerate the diagnosis and treatment of stroke patients.
The availability of such protocols is a key step in reducing
time to treatment as well as complications from treatment.
Emergency Medical Services
Emergency medical services (EMS) have a vital role in the
rapid transportation and survival of stroke patients.
Improved coordination between hospitals and EMS is a
cornerstone of a Primary Stroke Center. One element of a
well integrated system would be effective communication
between EMS personnel and the stroke center during rapid
transport of a patient experiencing a stroke.
The emergency department staff should have training in
diagnosing and treating stroke and have good lines of
communication with both EMS and the acute stroke team.
A Primary Stroke Center wishing to provide care beyond the
initial life-threatening period should have access to a
Stroke Unit where patients can receive specialized
monitoring and care. Some hospitals may choose to
stabilize patients and transfer them to another facility.
Primary Stroke Centers should be able to provide
neurosurgical services to stroke patients within two hours
of when the services are deemed necessary.
Support Of Medical Organization
The facility and its staff, including administration, should
be committed to the Primary Stroke Center. This
comprehensive commitment ensures the delivery of high
quality and efficient care to acute stroke patients.
The ability to perform brain imaging studies on acute stroke
patients is vital for physicians to make a fast, accurate
diagnosis of stroke patients. Brain imaging studies include
CT scans. A Primary Stroke Center must be capable of
performing an imaging study within 25 minutes of the
physician's order. The image should be evaluated by a
physician within 20 minutes of completion.
Standard laboratory services should be available around-the-
clock, seven days per week at a Primary Stroke Center.
Standard laboratory services include rapidly performing and
reporting blood counts, blood chemistries and coagulation
studies. A Primary Stroke Center also should be able to
rapidly obtain ECG and chest x-rays.
Primary Stroke Centers should have a database or registry
for tracking the number and type of stroke patients seen,
their treatments, timeline for treatments and some
measurement of patient outcome.
The professional staff of a Primary Stroke Center should
receive at least eight hours per year of continuing medical
education credit. In addition to professional education,
the Primary Stroke Center should plan and implement at least
two annual programs to educate the public about stroke
prevention, diagnosis and availability for emergency