HB-1145 and LVO ScalesSara Brown, MD FACEP

Parkview Regional EMS Medical Director

Board Certified EMS Physician

Indiana EMS Commission

CDC Stroke Death Rates

https://www.in.gov/isdh/27347.htm

CDC Stroke Death Rates

https://www.in.gov/isdh/27347.htm

Indiana HB-1145

Indiana State Department of Health

• list of certified hospitals

• list of Indiana network participating hospitals

Indiana State Department of Homeland Security

• EMS Commission

• EMS Protocols

• Stroke assessment tool

EMS Commission

EMS Commission Stroke Workgroup

•EMS Commission Members

•American Stroke Association

• Indiana Hospital Association

• Indiana Stroke Consortium of Indiana

• Indiana Department of Health

S

• Stroke Ready Hospitals → 1

• Primary Stroke Centers → 36

• Comprehensive Stroke Center → 1

Indiana Stroke Hospitals

EMS Commission Rule Draft

Indiana State Department of Health

• list of certified hospitals

• list of Indiana network participating hospitals

HB-1145

•Certified Stroke Hospitals• Provide ISDH with copies of certification and dates

• Notify ISDH not more than 48 hours after change

“Indiana network participating hospitals”

HB-1145

•Network participating hospital• Must provide ISDH with a copy of the written transfer agreement

LVO Screening Tools

LVO Process

Recognize symptoms

Call 911; Dispatch Screen

EMS Assessment and transport

ER / CT / TPA?

Transfer to intervention

center

CTA/CTP

Intervention

LVO Screening Tools

NIH LAMS RACE

CSTAT FAST-ED

NIH / Heidner 2016

• Anterior Circulation Strokes only

• Cut-off > 7

• Sensitivity 81.0 %

• Specificity 76.6 %

• Best sub-items• Best gaze

• Visual fields

• Motor arms

• Aphasia / neglect

J Neurol. 2016 Aug;263(8):1633-40. doi: 10.1007/s00415-016-8180-6. Epub 2016 Jun 6.

RACE

• 6 items

• Sensitivity 55%

• Specificity 87%

LAMS

• 3 tests

• Sensitivity 66%

• Specificity 86%

CSTAT

• 3 tests

• Sensitivity 56%

• Specificity 85%

FAST-ED

• 5 tests

• Sensitivity 71%

• Specificity 78%

Stroke. 2016 August ; 47(8): 1997–2002. doi:10.1161/STROKEAHA.116.013301.

Questions?