A stroke happens when blood flow to a part of the brain is interrupted because a blood vessel in the brain is blocked or bursts open. The sudden death of some brain cells due to a lack of oxygen when the blood flow to the brain is impaired by blockage (Ischemic) or rupture (Hemorrhagic) of an artery to the brain. Stroke is also called a Cerebrovascular Accident or CVA for short. Ischemic strokes are caused by the blockage of a blood vessel and Hemorrhagic strokes are caused by bleeding in the brain. According to the American Heart Association/American Stroke Association (AHA/ASA) the Ischemic Stroke is the most common and accounts for about 87 percent of all strokes.

The most common symptoms of a stroke include:

  • Weakness or paralysis on one side of the body.
  • Partial or complete loss of voluntary movement or sensation in a leg or arm.
  • Speech problems.
  • Weak face muscles, causing drooling.
  • Numbness or tingling.

A stroke involving the base of the brain can affect balance, vision, swallowing, and breathing and even cause unconsciousness.

A stroke is a medical emergency.  Anyone suspected of having a stroke should call 911.  Calling 911 ensures immediate care and transfer to the most appropriate medical facility for diagnosis and treatment.

The AHA/ASA and the Joint Commission describe studies that illustrate better outcomes when strokes are approached as a systematic plan. Early use of anticoagulants to minimize blood clotting has value in some patients as does treatment of blood pressure that is too high/low And controlling primary diseases such as Diabetes.

Local Stroke Systems

Some local EMS agencies (LEMSAs) have developed Stroke Care Systems. The systems vary among LEMSAs. The AHA/ASA is conducting a detailed survey on Stroke system approaches. To date, the EMS Authority has identified the following LEMSAs as developing/implementing an approach to Stroke Care: Alameda, Coastal Valleys, Contra Costa, Inland Counties, Kern, Los Angeles, Monterey, Orange, Sacramento, San Diego, San Francisco, San Mateo, Santa Clara, Sierra Sacramento and Ventura EMS.

Stroke Regulations

California statute mandates the EMS Authority to adopt necessary regulations to carry out the coordination and integration of all state activities concerning EMS (Health and Safety Code § 1797.107).

In addition, State statute allows the EMS Authority to establish guidelines for hospital facilities, in cooperation with affected medical organizations, according to critical care capabilities (Health and Safety Code § 1798.150).

As a result of these statutes, the EMS Authority established a multidisciplinary stroke taskforce for the development of Stroke System of Care Regulations for California.

The key areas to be addressed within the regulatory recommendations are: hospital designation criteria, data collection and quality improvement processes, time-critical intervention values and pre-hospital EMS policies. The overall goal of the regulations is to reduce morbidity and mortality from acute Stroke disease by improving the delivery of emergency medical care within local communities in California.

Stroke Critical Care Regulations

The Early Management of Adults with Acute Stroke

The EMS Authority staff participated in a Stroke Work Group co-convened by the American Heart & Stroke Association and the California Department of Public Health, Stroke & STEMI Prevention Program. The work group developed the Stroke guidelines titled “Recommendations for the Establishment of an Optimal System of Acute Stroke Care for Adults”, A Statewide Plan for California.

For Questions Contact

Farid Nasr, MD
Specialty Care Systems Specialist
(916) 322-4336 ext. 424