Table 2.

Acute stroke system challenges, TCC Coordinated SBST core functions, and examples of forms.

Stroke system components and challenges	TCC coordinated SBST core function (required)	Examples of forms (strategies that are optional or may be tailored to achieve core functions)
Prehospital SBST • Limited adoption of SBST • Limited data to support SBST	• Interviews with EMS Regional Directors to develop region/county specific SBST transport protocols • TCC assists in choice of destination and coordination of transport mode (ground vs. air)	• Longer transport limits in rural and suburban regions compared to urban locations • Modification of transport limits by resource availability • Air transport from rural locations when weather permits • Patient “hand-off” from one EMS unit to another to facilitate longer transports and keep units available in regions with limited EMS resources • Mobilization of back-up EMS units in regions with limited EMS resources when an out of region transport is initiated
Emergency Department (ED) SBST • Variable LVO scale use in the ED • Delays to cerebrovascular imaging • Delays to initiation of transfer process at non-MTCs • Delayed mobilization of team for inter-facility transfer • Limited transport resources, especially in rural areas	• Interviews with stroke center directors and coordinators to develop stroke center protocols • Regional symposia to review SBST plans, train coordinators, and provide “toolkit” to streamline ED stroke care • Active TCC monitoring in the ED every 20 min for suspected LVO patients prior to transfer • TCC assists in choice of MTC for transfer	• EMSA or another LVO scale included in code stroke on patient arrival • NIHSS included in code stroke on patient arrival • Combined CT/CTA on code stroke patients with suspected LVO • Combined CT/CTA/CTP on code stroke patients with suspected LVO • Telestroke consultation • Image sharing with MTC • Transition from alteplase to tenecteplase to facilitate rapid treatment and transfer • TCC proactively mobilizes transport team for secondary triage • Initial EMS unit remains until transfer decision is made (“Stroke Rescue Stop”) • Mobilization of neuro-interventional team once transfer decision is made • Transport to MTC ED or directly to angiography suite

TCC, Trauma Communications Center; SBST, Severity-Based Stroke Triage; LVO, Large Vessel Occlusion; MTC, Mechanical Thrombectomy Center; CT, Computerized Tomography; CTA, CT Angiography; CTP, CT Perfusion.