What is the “Chain of Survival” in patients with stroke in Canada?
Wieslaw Oczkowski: The “Chain of Survival” is a very interesting concept and, to be honest, when I was asked to answer some questions for this conference I had to actually look up the “Chain of Survival.” The “Chain of Survival” is a concept that I think is more common maybe in the United States and not necessarily in Canada and much more common in people with cardiological disorders.
But, in fact, we do have the “Chain of Survival” for somebody with a stroke. In somebody with a stroke it is survival and decreasing morbidity, because the difference between stroke and cardiological disease and many other disorders is that it is not just about death — it is about preventing impairment.
The “Chain of Survival” for somebody with a stroke includes education of the general public to identify the stroke warning signs. It is the chain that precedes the paramedic support services that need to identify that somebody is having a stroke and then need to triage them appropriately to the appropriate stroke services — regional or district centers, or comprehensive stroke centers versus primary stroke centers. It is the “Chain of Survival” that includes the emergency medical service that identifies the individual with stroke that then activates stroke programs within hospital services. The “Chain of Survival” proceeds to admitting people to stroke units to improve their best outcome, and a stroke unit admission requires admission to an acute stroke unit with a transfer to a rehabilitation stroke unit with a transition to the outpatient rehab services for somebody who requires rehabilitation and back to integration into the community.
I think the “Chain of Survival” for somebody with a stroke is a long chain, which starts with public awareness right to community integration.