Hawaii Stroke Coalition (HSC) is a 501(c)(3) tax exempt non-profit corporation that oversees the stroke system of care in Hawaii. HSC evolved from a Stroke Task Force that was convened in 2013 in response to Hawaii Senate Concurrent Resolution 155 to study the impact of a statewide stroke system of care in Hawaii. It is now a multi-organization community stakeholder group consisting of voting members from every acute care hospital in Hawaii, the Hawaii EMS Branch Chief and County Medical Directors, and representatives from Hawaii DOH, American Heart Association (AHA), and other stakeholders. HSC is recognized in Hawaii Statute Act 211 of 2015 as an advisory body to Hawaii EMS to identify stroke-capable hospitals, prehospital stroke recognition tools, and prehospital treatment and transfer protocols for patients with suspected stroke. Act 211 also requires all Hawaii hospitals who receive suspected stroke patients from EMS to report quality data to the statewide stroke quality improvement registry, which is currently Get with the Guidelines (GWTG)-Stroke. HSC coordinated with hospitals and EMS to establish a three-tiered recognition program for stroke capable hospitals, prehospital stroke activation using the Los Angeles Prehospital Stroke Screen (LAPSS), and public education campaigns, among other accomplishments. HSC published criteria for “Hawaii-designated stroke capable hospitals” which do not seek national accreditation as a Primary Stroke Center (PSC) or Comprehensive Stroke Center (CSC) but are important safety net hospitals in the system of care. This designation is included in the Hawaii EMS Transportation Guidelines for acute stroke. HSC also implemented EMS bypass rules on Oahu for suspected large vessel occlusion (LVO) stroke patients using the Cincinnati Stroke Triage Assessment Tool (C-STAT) as an EMS-administered prehospital LVO recognition tool. Beginning in July 2019, we undertook EMS provider training for C-STAT for prehospital recognition of patients with suspected LVO strokes. In October 2019, we implemented new Oahu EMS triage and transfer guidelines in which EMS would bypass the nearest hospital and directly transport patients who were LAPSS+ and C-STAT+ to a CSC for potential treatment with mechanical thrombectomy.
