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A stroke occurs when the blood supply to the brain is cut off by an artery in the brain that either ruptures or is blocked, cutting off critical oxygen supply to neurons. Approximately 80 percent of neurons die within three hours of the time that oxygen is cut off; therefore, rapid action is critical to prevent irreversible brain damage. Healthcare professionals working with adult patients have developed a catchphrase—“Time is brain”—recognizing that acute stroke recognition and treatment is of premier importance to preserve brain tissue, limit the amount of disability patients suffer in the long-term, and increase the stroke survival rate.

In order to save time—and potentially brain function—in patients that have suffered a stroke, the American Heart Association and the American Stroke Association have developed a community-oriented “Stroke Chain of Survival” that links specific actions to be taken by patients and family members with recommended actions by stroke prehospital care providers, emergency department (ED) personnel and in-hospital specialty services.

The “Stroke Chain of Survival” is characterized by four sequential stages, including

• Rapid recognition and reaction to acute stroke warning signs;
• Rapid emergency medical services (EMS) dispatch;
• Rapid EMS system transport and prearrival notification to the receiving hospital; and
• Rapid diagnosis and treatment in the hospital.

These four stages within the “Stroke Chain of Survival” include the execution of seven distinct steps in acute stroke diagnosis and treatment, also known as the Seven D’s. The seven steps also highlight the key points at which delays can occur, necessitating organized and efficient care at each step to avoid needless delays. The Seven D’s of stroke care, as well as the major actions to be performed in each step, are:

1. Detection of the onset of signs and symptoms of acute stroke. Early recognition of hallmark signs and symptoms of acute stroke is critical to improved patient outcomes.
2. Dispatch of EMS by telephoning 911 or another emergency response number. This communication activates EMS systems and ensures prompt EMS response.
3. Delivery of patient to a medical facility. Patients should be transported to a stroke hospital or other facility capable of providing acute stroke care, and advanced prehospital notification should be given to the selected medical facility.
4. Door of the emergency department (ED). Immediately upon arrival, the patient should undergo general and neurologic assessment in the ED.
5. Data collection, including computer tomography (CT) scan and serial neurologic exams, along with reviews of patient file for potential fibrinolytics (tPA) exclusions.
6. Decision regarding stroke treatment. If the patient remains a candidate for tPA therapy, review risks and benefits with patient and family and obtain informed consent for tPA therapy.
7. Drug administration as appropriate, and post-administration monitoring.

The window for administering treatment after a stroke is very limited. From the onset of stroke to the administration of treatment at a hospital or other medical facility, the Institute of Neurological Disorders and Stroke (NINDS), a branch of the National Institutes of Health (NIH), recommends that no more than three hours elapse to ensure improved patient outcomes and maximize the chance of stroke survival.

"Time is brain" is more than a catchphrase—it is a call to arms in acute stroke care. Healthcare providers, hospitals and communities must rally to develop streamlined response systems to execute the Seven D’s of stroke survival and give stroke victims the best care possible, the best chance of survival and the best chance for resuming a normal life.

For more information on stroke training, or acute stoke certification, visit the overview of stroke courses offered online.

The information included in this article is based on the 2020 guidelines for CPR, first aid and advanced cardiovascular care.