Hyperacute

The Heart and Stroke Foundation of Ontario conducts public awareness campaigns promoting the warning signs and symptoms of stroke using a variety of methods including television ads, print media and local events.

• Stroke Signs and Symptoms: FAST

• Paramedic Prompt Card for Acute Stroke Bypass Protocol

• Click here for this Paramedic Prompt Card

Pre-Hospital Los Angeles Motor Scale (LAMS) for Stroke Severity  

Paramedics across Ontario are using the LAMS to help identify possible large vessel occlusion (LVO) stroke and potential eligibility for Endovascular Thrombectomy (EVT).  The LAMS is being used as a secondary screen for those with stroke symptoms within 6 hours of onset.

• CorHealth Ontario LAMS Educational Video and Presentation for EMS providers:
  •  LAMS Training for EMS Providers
  •  LAMS Self-Training and Education Module
  •  Quiz
•  Southeastern Ontario brief LAMS resources: 
  • Pocket card
  • Poster 

Educational Workshop for Emergency Medical Services Care of Suspected Acute Stroke Patients

A Resource for Implementation of Canadian Best Practice Recommendations for Stroke: Emergency Medical Services Management of Suspected Stroke Patients. This resource is comprised of two components: Core content that can be integrated into educational materials and a comprehensive workshop package.

• Resource

Paramedic Chiefs of Canada: Stroke Care and recent updates to Heart and Stroke Foundation's Stroke Best Practice guidelines/protocols

• View Webinar

Regional and District Acute Stroke Protocol

Acute Stroke Protocol: KHSC-Kingston General Hospital Site

• KGH ED Poster - Emergency Guide for Thrombolysis and/or Endovascular Thrombectomy (EVT)
• KGH In-Hospital Poster - Internal Activation of the Acute Stroke Protocol
• KHSC-KGH site ACT-FAST Poster -EVT screening tool for patients presenting with stroke symptoms between 6-24 hours
• Rationale Guidelines for the use of Thrombolysis, Endovascular Thrombectomy (EVT) or both in the treatment of acute ischemic stroke at KGH
• Stroke/TIA Consult-History and Physical Assessment (for Physicians)
• "Protected" Acute Stroke Protocol guide for ED
• "Protected" Acute Stroke Protocol guide for In-hospital 
• Roles and Responsibilities for Thrombolytic Therapy and Endovascular Thrombectomy
• Presentation on Achieving Best Practice Target Times for Hyperacute Treatments -What we Learned
• Presentation on TNK instead of tPA: Experience at KHSC 
• Communication Message for ED regarding TNK instead of tPA including TNK dosing guideline
• Communication Message for Inhospital Areas regarding TNK instead of tPA including TNK dosing guideline

Acute Stroke Protocol: KHSC-Hotel Dieu Hospital Site

• Hotel Dieu Hospital Acute Stroke Protocol 
• Presentation with HDH UCC team on Acute Stroke Protocol and  ACT-FAST

If you have any questions about the Regional Acute Stroke Protocol, please contact Cally Martin, Regional Director, cally.martin@kingstonhsc.ca or Colleen Murphy, Regional Stroke Best Practice Coordinator, colleen.murphy@kingstonhsc.ca 

Regional Acute Stroke Protocol - Referring Centres

• Emergency Transfer Poster - Transfer Guide for Thrombolytic Therapy and/or EVT for patients with an acute ischemic stroke who may be eligible for treatment at KGH
• Regional Acute Stroke Protocol Repatriation Agreement for facilitating repatriation of patients with stroke between hospitals in Southeastern Ontario 

Quinte Code Stroke Video

Reinactment of a "Code Stroke" using telestroke at Quinte Health Care.

• Quinte Code Stroke Video (Full Version)
• Quinte Code Stroke Video (Short Verion)- emphasis on Paramedic role

Emergency Stroke Care: How are we doing?

Annual Evaluation - Presentation made to the Southeastern Ontario Regional and District Acute Stroke Protocol Committee

• RASP Overview June 2022

Endovascular Thrombectomy (EVT)

KGH Endovascular Thrombectomy

KHSC-KGH site has completed a weekday pilot study of EVT that selects eligible patients using the ESCAPE Trial criteria. The service is now being delivered on a 24/7 basis. 

• Communiqué - overview of KHSC-KGH site Pilot and key best practices
• Quinte-KGH Stroke EVT Transfer Algorithm
• Quinte Belleville General Emergency Transfer Guide for EVT 
• EVT Family Education Booklet

ACT-FAST- Large Vessel Occlusion Screen

The ACT-FAST is a large vessel occlusion screen for EVT being used to guide decision making for triaging patients arriving in the Emergency Department with stroke symptoms between 6-24 hours. The ACT-FAST algorithm has high specificity and reliability for recognizing large vessel occlusion in severe stroke (Zhao et al., 2018). The Acute Stroke Protocol is activated for patients arriving within 6-24 hours of onset if ACT-FAST screen is positive. Once the Acute Stroke Protocol or Code Stroke is activated, the physician will further determine patient eligibility for EVT. Patient selection for EVT is then based on advanced CT perfusion imaging using RAPID software. This imaging software helps quantify the amount of salvageable brain tissue and therefore assesses eligibility for EVT up to 24 hours in an evidence-based manner.

• KHSC-KGH site ACT-FAST Poster
• South East Community Hospital ACT-FAST Poster
• Provincial ACT-FAST education resource including videos

• Endovascular coiling procedure for ruptured and non-ruptured intracranial aneuyrsms is performed in Interventional Radiology at Kingston Health Sciences Centre. 
• Intracranial aneurysms are the dilation or ballooning of part of a blood vessel in the brain. When an intracranial aneurysm ruptures and bleeds, resulting in a subarachnoid hemorrhage, the mortality rate can be 40% to 50%, with severe morbidity of 10% to 20%.
• Endovascular coil embolization is a treatment option for intracranial aneurysm without the need for craniotomy. With endovascular coiling, a catheter is inserted into the femoral artery near the groin and navigated to the site of the aneurysm. Small helical platinum coils are deployed through the catheter to fill the aneurysm, and prevent it from further expansion and rupture. Coil embolization may be used with other adjunct endovascular devices such as stents and balloons. Anesthesiology support is required for the procedure which is done under general anesthesia. Ruptured intracranial aneurysms with subarachnoid hemorrhage must be repaired ASAP (same or next day) to prevent re-bleeding & vasospasm.
• Click here to learn more about how this coiling intervention is making an impact for patients. 
• Click here for a webinar by Dr. Donatella Tampieri about coiling and the elective processes. 
• Click here for recent lecture through Queen's University School of Medicine on Endovascular Treatment of Complex Cerebral Aneurysms by Dr. Brian Van Adel