6-24 Hr ACT-FAST Protocol

The RN Triage group will “Do the ACT-FAST to assess criteria for activation; if ambiguous, call more and activate less”.
Its is a Activate or Not protocol; when in doubt call the Stroke Staff on-call;
Checkout the excellent video primer below to see how actually qualifies. Remember, activation within 6-24H is for Access  to EVT - to get EVT patients have to meet  some clear criteria.

Here is a short just-in-time 10min. video explainer:

Of course, if you review the form and the patient meets criteria, just activate a code stroke.
If they clearly do not meet criteria, then don’t activate.
It is only if you are on the fence and are considering erring on the side of activating a code stroke, we are requesting you call the staff stroke staff on call to discuss. They can be reached by paging, or locating can transfer you directly to their cell phone.
After the discussion, they will either advise:
1) activate a code stroke
2) do not activate a code stroke (and proceed with typical ED triage/assessment). 

We've done our research on the Edge cases - last review of cases showed: 

The Stroke team was able to identify 5 of the 6 cases of treatment (TNK or EVT) in patients who didn’t meet criteria, and the big theme was significant neurologic deficit. This suggests that the ones to really consider calling are the patients with severe neurologic deficits but for some reason don’t officially meet criteria. In more detail:
-No clear last seen normal time so initially no code stroke, but patient developed worsening aphasia in waiting room and so then code stroke activated
-Severe neurological symptoms, but had relative contraindications (due to baseline functional status)
-Several episodes over 6-24h isolated aphasia (and also mild/mod arm weakness, but not drop to bed)
-Severe leg weakness but not arm
-Did not meet code stroke criteria as mild symptoms (NIHSS=2), however they happened to meet criteria for a clinical trial which included TNK.