HYPER ACute Care

New Virtual Learning Classroom Module : Management of the Upper Extremity Following Stroke

Hyper-Acute Care

Hyper-acute care involves all direct care, service delivery, and interactions from first contact with the healthcare system after the onset of an acute stroke to the movement of the patient to the acute inpatient care. Specifically, during transport to the hospital and in the emergency department.

Need for Hyper-Acute Care Practices

Over 1/3 of stroke patients do not contact emergency medical services for transport to a hospital and only 30% of patients arriving at the hospital are getting there within the 3.5 hour time frame to be eligible for acute thrombolysis. As a result, the time to brain imaging was prolonged and the time between hospital arrival and tPA administration was over 1 hour – exceeding the target 60 minute time frame. Canadian Stroke Best Practices Recommendations added the hyper-acute care guidelines with the aim to improve performance in these areas and reduce the time between stroke onset, arrival at a hospital, and treatment. The new hyper-acute stroke best practices are in place to help achieve this goal and improve outcomes for all stroke patients.

Hyper-Acute Care Principles

Hyper-acute stroke care is time sensitive and involves assessment, stabilization and treatment in the first hours after stroke or TIA onset. It represents all pre-hospital and initial emergency care for TIA and stroke. This includes thrombolysis or endovascular interventions for acute ischemic stroke, emergency neurosurgical procedures, and same-day TIA diagnostic and risk stratification evaluation.

The primary underpinnings of ‘hyper-acute stroke care’ are to RECOGNIZE and MOBILIZE. This starts with recognition of stroke symptoms by patients, families, and bystanders. The Heart and Stroke Foundation has launched a new signs of stroke campaign in 2014 that uses the FAST mnemonic (FACE, ARM, SPEECH, TIME) aiming to increase recognition of the signs of stroke and take appropriate action immediately. Mobilization has to occur without delay, from emergency medical services response to a potential new stroke patient, transport to hospitals with specialized stroke services, rapid access to neuroimaging, stroke specialists and time-sensitive treatments, such as acute thrombolysis and endovascular therapy. (Canadian Best Practice Recommendations, June 2015)

A coordinated and integrated approach to hyper-acute stroke care is emphasized within the West GTA Stroke Network, initiatives collaborating with Emergency Medical System, emergency departments, and other stakeholders involved in this phase of care.

Clinical Resources


Inclusion Criteria for Acute Ischemic Stroke Treatment: Acute Thrombolytic Therapy with Intravenous Altephase & Endovascular Thrombectomy Treatment Criteria

  • Absolute and Relative Inclusion Criteria checklist to guide clinical decision-making based in neuroimaging selection criteria

Prehospital Stroke Screening Tools: Standardized Acute Pre-Hospital Stroke Screening Tools

  • 15 standardized acute pre hospital screening tools for clinicans

 (ASPECTS): Understanding Alberta Stroke Program Early CT Score

  • 10 point qualitative score for the detection and assessment of early ischemic changes on non-contrast head CT to determine patient eligibility for receiving interventional mechanical thrombectomy treatment

Assessment Guide: Stroke Best Practice Pocket Assessment Guide

  • Common signs and symptoms, types of stroke, Canadian Neurological Scale, NIH Stroke Scale, FAST signs

FAST-ED Training Module: West GTA Stroke Network e-learning module

  • Provides a background on endovascular therapy for stroke
  • Reviews changes in acute stroke care management and provides an overview of the FAST-ED App 

The FAST-ED App is one tool for estimating the likelihood of large vessel occlusion and the utilization of this triage tool to promote efficient treatment with patients presenting with acute stroke symptoms.

Links to FAST ED app on the Apple Store and Google Play Store

FAST-ED app: Apple iOS

FAST-ED app: Android




Core Information Required by Dispatch, Paramedics, and Receiving Healthcare Facility: Core Information

EMS Timelines (Pre-Hospital and Emergency Department Phases) for eligibility for acute ischemic stroke therapy: EMS Management of Acute Stroke Patients

Emergency Department

Emergency Department Evaluation and Management: Emergency Department


Therapy: Acute Antiplatelet Therapy

Early Management of Patients Considered for Hemicraniectomy: Hemicraniectomy


Stroke Best Practices Website: Hyper-Acute Stroke Management Best Practices

Hyper-Acute Best Practice Update: 2018 update to guidelines for healthcare providers caring for people with current or recent symptoms of acute stroke or TIA

Canadian Stroke Best Practice Recommendations: Acute and Hyper-Acute Stroke Management Update 2018 PDF



Hyper-Acute Operational Committee

This area is utilize by the Hyper-Acute Operational Committee members to communicate and share resources. If you are an operational committee member, please click on the button below.


Regional Stroke Education and Hyper-Acute Coordinator

Megan Sousa

Email: megan.sousa@thp.ca

Phone Number: (905) 848-7580 Ext: 5006


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