TABLE 1.

The 8 D’s of Stroke Care

Detection: Involves recognizing the signs and symptoms of an acute stroke (BEFAST, Table 2)

Dispatch: Activation of emergency medical services. In most cases, this involves calling 911 or a stroke team

Delivery: Means prompt transport of the patient to a hospital, preferably a stroke center or to a setting in the hospital for further evaluation by a stroke team

Door: This refers to the arrival of the patient at the ED. According to recommendations from the National Institute of Neurological Disorders and Stroke, an assessment should be completed by an ED physician within 10 min of arriving in the ED

Data: Data collection includes results from laboratory tests and both a physical and a neurologic examination (Neurological Institutes of Health Stroke Scale)

Decision: Information, such as the type of stroke, last seen normal, and time from onset of symptoms, is considered before a treatment decision is made

Drug/device: Fibrinolytic therapy should be administered within 4.5 hr of the onset of symptoms. Even if the patient is not a candidate for fibrinolysis, they may still qualify for endovascular therapy to remove mechanically a clot

Disposition: It is recommended that patients are admitted to an ICU or stroke unit within 3 hr of arrival in the ED

ED = emergency department.

See Table 2 for BEFAST expansion.