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Proceedings of a National Symposium on Rapid Identification and Treatment of Acute Stroke image

NINDS: Stroke Proceedings: Appendix

Proceedings of a National Symposium on
Rapid Identification and Treatment of Acute Stroke
December 12-13, 1996

Appendices

Steering Committee Members

Chair

K.M.A. Welch, M.D.
Director, NMR Research and Headache Centers
Professor of Neurology, Case Western
Reserve University
Henry Ford Hospital and Health Sciences Center
Detroit

Members

William G. Barsan, M.D.
Director, Emergency Department
Professor, Department of Surgery
Head, Section of Emergency Medicine
University of Michigan Medical Center
Ann Arbor

Michael R. Frankel, M.D.
Chief of Neurology, Grady Health System
Assistant Professor, Emory University School of Medicine
Atlanta

Daniel F. Hanley, M.D.
Professor of Neurology, Departments of Neurology, Neurosurgery, and Anesthesia
Director, Neurological Critical Care
The Johns Hopkins Hospital
Baltimore

Cathryn M. Helgason, M.D.
Professor, Department of Neurology
University of Illinois Medical Center at Chicago

John R. Marler, M.D.
Medical Officer
Division of Stroke, Trauma, and Neurodegenerative Disorders
National Institute of Neurological Disorders and Stroke
Bethesda, Maryland

Thomas C. Royer, M.D.
Senior Vice President, Medical Affairs
Chairman, Board of Governors
Henry Ford Medical Group
Detroit

Judith A. Spilker, R.N., B.S.N.
Cerebrovascular Research Coordinator, Department of Neurology
University of Cincinnati Medical Center

NINDS Staff

Michael D. Walker, M.D.
Director
Division of Stroke, Trauma, and Neurodegenerative Disorders

Marian Emr
Director
Office of Communications and Public Liaison

Margo Warren
Chief, Public Liaison Section
Office of Communications and Public Liaison

Norman Oliver
Writer-Editor
Public Liaison Section
Office of Communications and Public Liaison

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Task Force Members

Prehospital and Hospital Care Task Force

Co-chairs

William G. Barsan, M.D.
Director, Emergency Department
Professor, Department of Surgery
Head, Section of Emergency Medicine
University of Michigan Medical Center
Ann Arbor

Michael R. Frankel, M.D.
Chief of Neurology, Grady Health System
Assistant Professor, Emory University School of Medicine
Atlanta

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Prehospital Subcommittee

Douglas J. Floccare, M.D., M.P.H., F.A.C.E.P.|
State Aeromedical Director
Associate State EMS Medical Director
Emergency Physician, Maryland Institute of Emergency Medical Services Systems
Baltimore

Paul E. Pepe, M.D., M.P.H., F.A.C.E.P., F.C.C.M., F.A.C.P.
Professor and Chair, Department of Emergency Medicine
Allegheny University of the Health Sciences, Allegheny Campus
Director, Emergency Services,
Allegheny General Hospital
Pittsburgh

Robert A. Swor, D.O.
President, National Association of Emergency Medical Services Physicians
Director of EMS Services, Department of Emergency Medicine
William Beaumont Hospital
Royal Oak, Michigan

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Emergency Department Subcommittee

Brooks F. Bock, M.D., F.A.C.E.P.
Dayanandan Professor and Chair, Department of Emergency Medicine
Wayne State University
Detroit Receiving Hospital

Joseph P. Broderick, M.D.
Professor, Department of Neurology
University of Cincinnati Medical Center

Joseph E. Clinton, M.D.
Professor of Clinical Emergency Medicine
University of Minnesota
Chief, Department of Emergency Medicine
Hennepin County Medical Center
Minneapolis

John A. Marx, M.D.
Clinical Professor of Emergency Medicin
University of North Carolina at Chapel Hill
Chair and Chief, Department of Emergency Medicine
Carolinas Medical Center
Charlotte, North Carolina

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Hospital/Neurologists Subcommittee

Anthony J. Furlan, M.D.
Head, Section of Adult Neurology
Director, Cerebrovascular Center
The Cleveland Clinic Foundation

James C. Grotta, M.D.
Director, Stroke Program
Professor, Department of Neurology
University of Texas Medical School
Houston

Walter J. Koroshetz, M.D.
Associate Director, Stroke and Clinical Neurology Services
Medical Director, Neurointensive Care Unit
Massachusetts General Hospital
Boston

Dennis Landis, M.D.
Chairman and Director, Department of Neurology
University Hospitals of Cleveland

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Health Care Systems Task Force

Chair

Thomas C. Royer, M.D.
Senior Vice President, Medical Affairs
Chairman, Board of Governors
Henry Ford Medical Group
Detroit

Members

Paul B. Batalden, M.D.
Director, Health Care Improvement Leadership Development
Dartmouth Medical School
Hanover, New Hampshire

Edward Feldmann, M.D.
Associate Professor of Neurology
Department of Clinical Neurosciences
Brown University School of Medicine
Providence, Rhode Island

Anthony J. Furlan, M.D.
Head, Section of Adult Neurology
Director, Cerebrovascular Center
The Cleveland Clinic Foundation

Steven R. Levine, M.D.
Division Head, Stroke Center for Stroke Research
Henry Ford Stroke Program
Clinical Associate Professor, Department of Neurology
Henry Ford Hospital and Health Sciences Center
Detroit

Christopher Lewandowski, M.D.
Residency Director, Department of Emergency Medicine
Henry Ford Hospital and Health Sciences Center
Detroit

J. Sanford Schwartz, M.D.
Executive Director, Leonard Davis Institute of Health Economics
University of Pennsylvania
Philadelphia

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Public Education Task Force

Chair

Judith A. Spilker, R.N., B.S.N.
Cerebrovascular Research Coordinator, Department of Neurology
University of Cincinnati Medical Center

Members

Carol A. Barch, M.N., C.R.N.P., C.N.R.N.
Program Coordinator, Stroke Institute
University of Pittsburgh Medical Center

Thomas G. Brott, M.D.
Professor of Neurology
Department of Neurology
University of Cincinnati Medical Center

Edward Feldmann, M.D.
Associate Professor of Neurology, Department of Clinical Neurosciences
Brown University School of Medicine
Providence, Rhode Island

Martha Hill, Ph.D., R.N.
Associate Professor, School of Nursing
The Johns Hopkins University
Baltimore

Karen Putney Iannella
Vice President, National Stroke Association
Englewood, Colorado

Thomas Kwiatkowski, M.D.
Chairman, Department of Emergency Medicine
Long Island Jewish Medical Center
New Hyde Park, New York

Norman A. Levy, M.S.
Director, Advertising Development
Procter & Gamble
Cincinnati

Patrick D. Lyden, M.D.
Staff Physician
Veterans Administration Medical Center
University of California at San Diego

William Thies, Ph.D.
Senior Science Consultant
Director, Stroke Division
American Heart Association
Dallas

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Partners

The following organizations have joined with the NINDS in the consensus-building process for developing a national acute stroke education program.

Agency for Health Care Policy and Research

Air Medical Physician Association

Alliance for Aging Research

American Academy of Emergency Medicine

American Academy of Neurology

American Academy of Nurse Practitioners

American Academy of Physician Assistants

American Association of Critical Care Nurses

American Association of Health Plans

American Association of Neurological Surgeons

American Association of Neuroscience Nurses

American Association of Occupational Health Nurses

American Association of Rehabilitation Nurses

American College of Cardiology

American College of Emergency Physicians

American College of Physicians

American College of Radiology

American Congress of Rehabilitation Medicine

American Geriatrics Society

American Health Care Association

American Heart Association

American Hospital Association

American Medical Association

American Neurological Association

American Nurses Association

American Red Cross

American Society of Interventional and Therapeutic Neuroradiology

American Society of Neuroimaging

American Society of Neuroradiology

Association of Schools of Allied Health Professions

Center for Emergency Medicine

Centers for Disease Control and Prevention

Child Neurology Society*

Commission on Accreditation of Medical Transport Systems

Congress of Neurological Surgeons

Council of Residency Directors

Dana Alliance for Brain Initiatives

Department of Defense, Health Affairs

Department of Veterans Affairs

Emergency Nurses Association

Food and Drug Administration

Health Care Financing Administration

Health Resources and Services Administration

International Association of Fire Fighters

National Academy of Emergency Medical Dispatch

National Association for Health Care Quality

National Association of Emergency Medical Services Educators

National Association of Emergency Medical Services Physicians

National Association of State EMS Directors

National Center for Health Statistics

National Coalition for Research in Neurological Disorders

National Council of State Emergency Medical Services Training Coordinators

National Flight Nurses Association

National Foundation for Brain Research

National Heart, Lung, and Blood Institute

National Highway Traffic Safety Administration

National Institute of Nursing Research

National Medical Association

National Registry of Emergency Medical Technicians

National Stroke Association

Society for Academic Emergency Medicine

Society for Nuclear Medicine

Society of Cardiovascular and Interventional Radiology

Society of Critical Care Medicine

Society of Emergency Radiology

*Representatives of the Child Neurology Society provided the Symposium organizers with a written statement addressing the special needs of children who experience stroke.

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Speakers

Carol A. Barch, M.N., C.R.N.P., C.N.R.N.
Program Coordinator, Stroke Institute
University of Pittsburgh Medical Center
200 Lothrop Street
Suite C422/PUH
Pittsburgh, Pennsylvania 15213

William G. Barsan, M.D.
Director, Emergency Department
Professor, Department of Surgery
Head, Section of Emergency Medicine
University of Michigan Medical Center
1500 East Medical Center Drive
Ann Arbor, Michigan 48109-0014

Robert R. Bass, M.D.
Executive Director, Maryland Institute of Emergency Medical Services Systems
36 West Lombard Street, Room 201
Baltimore, Maryland 21201-1528

Brooks F. Bock, M.D., F.A.C.E.P.
Dayanandan Professor and Chair, Department of Emergency Medicine
Wayne State University
Detroit Receiving Hospital
4201 St. Antoine Street
Detroit, Michigan 48201

Joseph P. Broderick, M.D.
Professor, Department of Neurology
University of Cincinnati Medical Center
231 Bethesda Avenue, Room 4305 MSB
Cincinnati, Ohio 45267-0525

Joseph E. Clinton, M.D.
Professor of Clinical Emergency Medicine
University of Minnesota
Chief, Department of Emergency Medicine
Hennepin County Medical Center
701 Park Avenue
Minneapolis, Minnesota 55415-1829

James Dunford, M.D.
City of San Diego EMS Medical Director
Clinical Professor, Department of Emergency Medicine
University of California, San Diego Medical Center
200 West Arbor Drive
San Diego, California 921o3-8676

Edward Feldmann, M.D.
Associate Professor of Neurology, Department of Clinical Neurosciences
Brown University School of Medicine
110 Lockwood Street, Suite 324
Providence, Rhode Island 02903

Douglas J. Floccare, M.D., M.P.H., F.A.C.E.P.
State Aeromedical Director
Associate State EMS Medical Director
Emergency Physician, Maryland Institute of Emergency Medical Services Systems
636 West Lombard Street
Baltimore, Maryland 21201-1528

Michael R. Frankel, M.D.
Chief of Neurology, Grady Health System
Assistant Professor, Emory University School of Medicine
80 Butler Street, SE, Box 036
Atlanta, Georgia 30335

Anthony J. Furlan, M.D.
Head, Section of Adult Neurology
Director, Cerebrovascular Center
The Cleveland Clinic Foundation
9500 Euclid Avenue
Cleveland, Ohio 44195-5001

James C. Grotta, M.D.
Director, Stroke Program
Professor, Department of Neurology
University of Texas Medical School
6431 Fannin, MSB 7044
Houston, Texas 77030

Daniel Hankins, M.D., F.A.C.E.P.
Co-Medical Director, Mayo Medical Transport
Mayo Clinic
200 First Street, SW
Rochester, Minnesota 55905

Linda K. Honeycutt, EMT-P
EMS Programs Coordinator, Department of Emergency Medicine
Providence Hospital and Medical Centers
16001 West Nine Mile Road
Southfield, Michigan 48075

Walter J. Koroshetz, M.D.
Associate Director, Stroke and Clinical Neurology Services
Medical Director, Neurointensive Care Unit
Massachusetts General Hospital
Fruit Street
Boston, Massachusetts 02114

Dennis Landis, M.D.
Chairman and Director, Department of Neurology
University Hospitals of Cleveland
11100 Euclid Avenue
Hanna House 5040
Cleveland, Ohio 44106

Steven R. Levine, M.D.
Division Head, Stroke Center for Stroke Research
and Henry Ford Stroke Program
Clinical Associate Professor, Department of Neurology
Henry Ford Hospital and Health Sciences Center
2799 West Grand Boulevard
Detroit, Michigan 48202-2689

Norman A. Levy, M.S.
Director, Advertising Development
Procter & Gamble
1 Procter & Gamble Plaza, C-8
Cincinnati, Ohio 45202-3315

Christopher Lewandowski, M.D.
Residency Director, Department of Emergency Medicine
Henry Ford Hospital and Health Sciences Center
2799 West Grand Boulevard
Detroit, Michigan 48202-2689

Patrick D. Lyden, M.D.
Staff Physician
Veterans Administration Medical Center
Director, Stroke Center
Associate Professor
University of California at San Diego
200 West Arbor Drive
San Diego, California 92103-8466

Edward W. Maibach, Ph.D., M.P.H.
Director, Research and Social Marketing Strategy
Porter Novelli
1120 Connecticut Avenue, NW
Washington, DC 20036-5800

John A. Marx, M.D.
Clinical Professor of Emergency Medicine
University of North Carolina at Chapel Hill
Chair and Chief, Department of Emergency Medicine
Carolinas Medical Center
PO Box 32861
Charlotte, North Carolina 28232-2861

Thomas C. Royer, M.D.
Senior Vice President, Medical Affairs
Chairman, Board of Governors
Henry Ford Medical Group
Corporate Offices
1 Ford Place
Detroit, Michigan 48202

Michael R. Sayre, M.D.
Assistant Professor of Emergency Medicine, Department of Emergency Medicine
University of Cincinnati Medical Center
231 Bethesda Avenue, ML 769
Cincinnati, Ohio 45267-0769

Judith A. Spilker, R.N., B.S.N.
Cerebrovascular Research Coordinator, Department of Neurology
University of Cincinnati Medical Center
231 Bethesda Avenue, Room 4305 MSB
Cincinnati, Ohio 45267-0525

Thomas M. Stein, M.D.
Medical Director, LifeFlight and EMSS
Allegheny General Hospital
320 East North Avenue
Pittsburgh, Pennsylvania 15212

Harold W. (Pete) Todd
US Air Force (Ret.)
President, National Stroke Association
9707 East Easter Lane
Englewood, CO 80112-3747

Carl C. Van Cott
Communications Specialist, North Carolina Office of Emergency Medical Services
701 Barbour Drive
Raleigh, North Carolina 27603-2008

K.M.A. Welch, M.D.
Director, NMR Headache Research Centers
Professor of Neurology, Case Western Reserve University
Henry Ford Hospital and Health Sciences Center
2799 West Grand Boulevard
Detroit, Michigan 48202-2689

Brian S. Zachariah, M.D., F.A.C.E.P.
Assistant Professor of Surgery, Division of Emergency Medicine
University of Texas-Southwestern Medical Center
Emergency Medicine Education, E6110
5323 Harry Hines
Dallas, Texas 75235-8890

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Acknowledgments

This publication and the December 1996 Acute Stroke Symposium were supported in part with public education grants from Genentech Inc., Janssen Pharmaceutica, and an endowment from the estate of Portia Rae Parkins. The recommendations recorded in this volume represent the consensus of opinion expressed at the symposium by a wide range of participants, including public, private, and voluntary organizations involved in the effort to improve the delivery of care and treatment to acute stroke patients.

As scientists and health care providers continue to refine the current treatments for stroke and develop other potential treatments, some of the guidelines presented in this volume may change. The recommendations developed during the Symposium and presented in this volume are intended to help health professionals make more informed decisions concerning the care of their individual patients. As always, those responsible for direct patient care will base their treatment decisions primarily on information they gather from their patients and the circumstances specific to those patients. This volume will assist in making those decisions but is not intended to replace the expertise available only to those in direct contact with stroke victims.

The editors wish to acknowledge the following for their help in developing and publishing this volume:

Michael D. Walker, M.D., NINDS, for his creative management of the NINDS stroke research program that has generated, and continues to generate, important insights into the causes, diagnosis, and treatments of stroke, and for his intellectual contributions to the design and implementation of the Acute Stroke Symposium.

Margo Warren, NINDS, for Symposium planning.

Ann Haynos, NINDS, for editorial assistance.

Rayne Ann Wood, NIH, for publication design.

Betty Hebb, NIH, for original cover art.

Pamela Winters Jones dedicates her contributions to this publication to her mother Thelma M. Winters who died on March 7, 1997, of a stroke.

For additional copies of these Proceedings contact:

Office of Communications and Public Liaison

Prepared by

Office of Communications and Public Liaison

National Institute of Neurological Disorders and Stroke

National Institutes of Health

Bethesda, Maryland 20892

NIH Publication No. 97-4239

August 1997

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Last Edited: January 13, 2000

National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

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Research Spotlight

NINDS: Stroke Proceedings: Appendix

Appendices

Chair

Members

NINDS Staff