Development of a metropolitan matrix of primary stroke centers: The Phoenix experience

Background and Purpose - In 1998, 2947 patients in metropolitan Phoenix were hospitalized for acute cerebral infarction. Only 2 of the 26 regional hospitals satisfied criteria for primary stroke center ( PSC) designation. Fewer than 1% of patients with ischemic stroke received tissue plasminogen activator for thrombolysis. We sought to develop and evaluate the effectiveness of a metropolitan prehospital emergency medical system for effectively identifying and transporting patients with acute stroke to a matrix of predesignated PSCs and increasing to 20% the proportion of all such patients receiving tissue plasminogen activator. Methods - The American Stroke Association Phoenix Operation Stroke partnered with the Arizona Emergency Medical Systems in 1998 to 1999 to list goals and objectives, identify key stakeholders, and develop committees to address community education, emergency medical system training, and PSC designation. Results - Over 8 years, emergency medical system personnel were trained to identify and transport patients with acute stroke to PSCs, 8 hospitals met PSC criteria, the metropolitan matrix of PSCs became operational ( in 2003), and 18% of patients with acute ischemic stroke received thrombolysis. Conclusions - It is feasible to develop and operationalize a successful metropolitan- wide matrix of PSCs to accommodate emergency medical system- identified and transported patients with acute stroke in a 9000- square- mile region with a population of 3.5 million people.