Ambulance Destination Policies

Four Regional Acute Stroke Destination Policies have been developed for New Zealand by the National Stroke Network and the ambulance sector.

Summary of key changes

Acute stroke

• A 6 hour transport timeframe (from the time of symptom onset) has been included in the destination policy for patients being transported to Auckland City Hospital, Wellington Regional Hospital or Christchurch Hospital reflecting the extended treatment window that stroke clot
  provides for patients eligible for SCR.

• ‘Wake-up’ stroke criteria has been added to all stroke pathways due to CT perfusion (CTP) scanning being increasingly utilised. Nearly 3/4 of DHBs have requested that ambulance staff treat patients who have awoken with signs or symptoms of stroke acutely; for simplicity and consistency we have added ‘wake-up’ stroke criteria in all pathways nationally; the idea being that ambulance personnel will pre-notify ED and expedite transport for patients who have awoken with signs/symptoms of stroke to give DHBs the opportunity to treat these patients acutely if they elect to.

• The PASTA tool has been added to the Midland Acute Stroke Destination Policy as an additional form of triage following completion of the FAST test, at the request of the Regional Stroke Network. Ambulance staff in the Midland Area will now advise the PASTA test results (in addition to FAST results) when notifying hospital personnel of the patient’s impending arrival.

• Lakes District Hospital (Queenstown) is now a 24/7 stroke hospital.

The destination policies:

• Confirm the clinical criteria to diagnose acute stroke in the out-of-hospital setting and

• Confirm the ‘cut off’ time for direct transport to a stroke hospital and

• Specify which hospitals are designated as stroke hospitals in each region.

Patients with an acute stroke who can be transported to a designated stroke hospital within four hours of the onset of symptoms will be transported directly to a stroke hospital (utilising the appropriate Regional Acute Stroke Destination Policy) whenever it is feasible and safe to do so. The policies also reinforce the importance of ambulance personnel providing hospital personnel with as much pre-notification as possible and providing the patient’s NHI (if known) during pre-notification.

The Acute Stroke Destination Policies represent an exciting opportunity to improve outcomes for patients with an acute stroke by ensuring patients have prompt access to reperfusion therapy if indicated.