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About the Coalition

Representing medical, scientific, advocacy, and government professionals from across the stroke continuum, the Brain Attack Coalition is dedicated to setting direction, advancing knowledge, and communicating best practices to improve our ability to prevent and combat stroke.

Professional resources include Guidelines and Orders for systems development for acute stroke care (including stroke team or stroke center development), and Pathways for the rapid diagnosis and treatment (both immediate and long-term) of acute stroke.

Patient Resources includes links to sites that provide helpful information to stroke patients, their families and caregivers.

Coalition Initiatives

Important new information about the rapid diagnosis and treatment of acute stroke is provided in this section. This includes research studies and articles from healthcare publications, as well as data, advice, guidelines, and recommendations sourced from Coalition members.



Brain Attack Coalition Adopts New Message for National Stroke Awareness Month

Bethesda, MD, May 13, 2009—In recognition of Stroke Awareness Month in May, a national stroke coalition today announced that its member organizations have adopted a new public education message: “Stroke strikes fast. You should too. Call 9-1-1.” The Brain Attack Coalition (BAC), chaired by the National Institute of Neurological Disorders and Stroke (NINDS) and composed of leading organizations committed to stroke prevention and treatment, recognized the need for a new actionable message that all member organizations can use with their current stroke awareness efforts. The NINDS is part of the National Institutes of Health.

Stroke Strikes Fast, You Should Too. Call 9-1-1″Stroke strikes fast. You should too. Call 9-1-1.” will begin to appear on many of the BAC organizations’ Web sites and will be widely introduced this month. The public will also begin seeing the new message incorporated into NINDS printed materials related to stroke.

“Our goal was to develop a memorable call to action that creates a strong sense of urgency and establishes a clear, actionable idea—act quickly and call 9-1-1 if stroke is suspected,” said Michael D. Walker, M.D., the coalition’s chair and a former division director at NINDS. “I am thrilled that the professional and patient organizations that make up the Brain Attack Coalition came together to drive home the point that stroke is a medical emergency. If more people know to dial 9-1-1, we can reduce the death and disability caused by stroke.”

The new uniform public education message builds on previous successes of the BAC, including the development of a universally agreed upon list of stroke symptoms to educate the public. Previously, each organization used slightly different descriptions of stroke, making it difficult to teach people about the range and varying severity of stroke symptoms. The symptoms are:

  • Sudden numbness or weakness of face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

The BAC has also authored two academic research papers outlining guidelines for stroke centers. The first paper, published in the Journal of the American Medical Association in June of 2000, presented guidelines for primary stroke centers which led to the development of a Joint Commission certification program for primary stroke centers. There are now 560 such stroke centers in the United States. The second paper outlined guidelines for comprehensive stroke centers and was published in the journal Stroke in July of 2005.

The Brain Attack Coalition is a group of professional, voluntary, and government organizations whose mission is to reduce the occurrence, disabilities, and death associated with stroke. The goal of the coalition is to strengthen and promote the relationships among its member organizations.

Coalition members include the: American Academy of Neurology; American Association of Neurological Surgeons; American Association of Neuroscience Nurses; American College of Emergency Physicians; American Society of Neuroradiology; American Stroke Association, a Division of American Heart Association; Centers for Disease Control and Prevention; Congress of Neurological Surgeons; Department of Veterans Affairs; National Association of EMS Physicians; The National Association of State EMS Officials; National Institute of Neurological Disorders and Stroke; National Stroke Association; Neurocritical Care Society; Society of NeuroInterventional Surgery; and Stroke Belt Consortium. The National Association of Chronic Disease Directors recently joined the Coalition.)

To view, download or link to a graphic of the new message, visit the NINDS stroke site at

The NINDS, part of the National Institutes of Health, is the nation’s primary supporter of biomedical research on the brain and nervous system. It is dedicated to research and education on the causes, treatment, and prevention of stroke.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

Stroke Symptoms Guide

  • Sudden numbness or weakness of face, arm, or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

Establishing a Stroke Center

  • JAMA Article Abstract: June 21, 2000
  • JAMA Article Fact Sheet: June 20, 2000
  • JAMA Article Press Release: June 20, 2000
  • Recommendations for Comprehensive Stroke Centers: July 2005 [PDF, 280KB]

Stroke Center Checklist for Communities

Do You Have Access to the Best Treatment for Stroke?

A Checklist for Communities

  • Does the hospital have a Stroke Team led by a healthcare professional with training and expertise in stroke? A Stroke Team is a professional staff available around the clock, seven days a week to evaluate the patient within 15 minutes of arrival.
  • Does the hospital have written guidelines for emergency treatment for stroke patients?
  • Does the city’s emergency medical system transport patients with suspected strokes as rapidly as possible to the hospital?
  • Is the hospital’s emergency department physicians trained to rapidly diagnose and treat acute stroke?
  • Does the hospital provide coordinated stroke care beyond the emergency department physician’s evaluation? If not, is the hospital prepared to transfer the patient to a hospital that does?
  • Does the hospital have a neurosurgeon available around the clock, seven days a week? If not, is the hospital prepared to transfer the patient to a hospital that does?
  • Is the hospital administration committed to the Stroke Center?
  • Does the hospital have capability around the clock, seven days a week to perform and interpret either a head CT scan or a brain MRI scan within 45 minutes of the stroke patient being admitted?
  • Is the hospital lab open around the clock, seven days a week?
  • Does the hospital track patient outcomes, perform ongoing program evaluation, and strive for improvements?
  • Does the hospital staff of the Stroke Center receive at least eight hours per year of continuing medical education?
  • Does the hospital have at least two annual programs to educate the public about stroke prevention, diagnosis, and the availability of acute therapies?

Stroke Scales

The five stroke scales in this section are used to evaluate a stroke patient, immediately or subsequently to experiencing an acute stroke.

  1. Barthel Index
  1. Glasgow Outcome Scale
  1. Hunt and Hess Classification of Subarachnoid Hemorrhage
  1. Modified Rankin Scale
  1. NIH Stroke Scale

Prehospital Stroke Scales

BREMSS The Birmingham Regional Emergency Medical Services System


Cincinnati Prehospital Stroke Scale


Dallas Stroke Council Stroke Evaluation Sheet

  • Protocols2004/StrokeEvalSheet.asp

Los Angeles Prehospital Stroke Screen


Miami Emergency Neurologic Deficit (MEND) Checklists