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Stroke considerations for flight

By: Kyla Ruf, RN, BSN, CCRN, Flight Nurse

A cerebral vascular accident (CVA), also called a stroke, occurs when there is a decreased blood supply to part of the brain. CVA’s can be either embolic (due to a clot) or hemorrhagic (due to a bleeding vessel). In either case, parts of the brain not receiving adequate perfusion become damaged or die. A stroke can cause lasting brain damage, long-term disability, and death if not treated in a timely fashion.

According to the CDC, in 2020 one in six deaths from cardiovascular disease was due to stroke. Every 40 seconds, someone in the US has a stroke. Every 3.5 minutes, someone dies of stroke.

As a flight crew, a large portion of our transports consist of patients needing care at Mercyhealth’s Comprehensive Stroke Center. There are many considerations to caring for stroke patients, but a huge component of our care revolves around ensuring we decrease the amount of time it takes to transport our patients to their designated care. There are several ways we accomplish this.

First and foremost, these patients need to be classified as needing transport to a comprehensive stroke center. This identification could occur in the field by EMS or interfacility. Rapid triage and determination of transport needs should be completed as quickly as possible. G-FAST has been utilized in our surrounding area with great success. A study completed by Mercyhealth’s neurology team at demonstrated significant reduction in door-to-intervention time when utilizing a GFAST stroke assessment scale. With this easy-to-use singular assessment tool, patients scoring >3 points can be rapidly identified as potentially needing thrombectomy and additional treatment at a comprehensive stroke center. This ability to readily recognize these patients has significantly decreased time to identification of transport need.

Next, transport needs to be activated to get your patient to their identified Comprehensive Stroke Center. At REACT, we’ve worked closely with Mercyhealth’s neurology team to ensure that the consultation and transport components of transferring a patient are seamless to minimize delay. REACT ensures time limitations are at the forefront of our care. We train to minimize disruptions in care while rapidly loading our patients (when appropriate) to decrease transport time significantly.

Lastly, we work closely with Mercyhealth’s stroke team to ensure patients arrive at the appropriate end destination as quickly as possible. We perform continuous neurological assessments, communicate with our neurologist frequently throughout our care, and will update with changes that may impact our patients care during all phases of transport. We also carry a wide range of medications including antihypertensives for the treatment of stroke patients. We receive the most up-to-date training including TNK and TPA administration, maintaining congruent care throughout all phases of transport. This ability to keep our comprehensive stroke team up-to-date with your patient’s condition ensures the best care possible.