New guidelines for stroke patients amid COVID-19

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A group of experts issued new guidance to ensure stroke patients receive safe and timely care while preventing transmission of the novel coronavirus (COVID-19), according to the new recommendations by University of Virginia Health System researchers published in the journal Stroke.

The guidelines urge the use of telemedicine to speed treatment and advise EMS crews how to determine the best facility to treat the patient's needs. The recommendations, from the American Heart Association's Stroke Council, come amid increasing concerns that stroke patients are delaying seeking care because of fear of COVID-19. Such delays can have catastrophic consequences, including death, the researchers said.

With stroke, every minute counts, and speedy care can be the difference in life and death. It can also prevent lifelong disability. For that reason, telemedicine experts at the University of Virginia have worked with local EMS personnel to pioneer the use of the technology for pre-hospital care. They've placed tablets inside ambulances to connect first responders with stroke experts, allowing stroke care to begin even before the patient arrives at the hospital. The new guidelines suggest this approach should be used widely.

The COVID-19 pandemic, however, adds an extra layer of complexity for first responders. In addition to the need for appropriate personal protective equipment, EMS crews must assess whether each patient has the coronavirus, the new guidelines note.

When possible, EMS workers should screen patients using free tools available online, the guidelines recommend. Responders should have a protocol in place in case the screening is positive or if the patient is incapacitated and can't be screened. The receiving hospital should be notified as well.

Stroke patients with COVID-19 are more likely to require a ventilator and intensive care, so emergency crews should consider taking patients to a hospital with the capacity to provide that level of care, the guidelines note. Emergency crews also may need to consider hospital capacity based on the number of cases in their region. And they may want to bypass emergency rooms to lessen exposure risk.

In all of this, communication between emergency crews and the receiving hospitals is key, the authors say.

"Now more than ever, during the COVID-19 pandemic, we need to work collaboratively and support our emergency medical services providers working day and night on the front lines for our community," Andrew Southerland, MD, one of the guidelines' authors, in a statement. "To achieve this, we must optimize communication and prehospital care for patients. Nowhere is this more important than in rural networks like surrounding areas in Central Virginia."

Editor’s note: Click here for more information and ongoing COVID-19 updates for integrative healthcare professionals.