Alabama Statewide Stroke System Overview

When a stroke occurs, every second counts. Rapid recognition, timely evaluation, and immediate access to specialized care can significantly impact patient outcomes. The Alabama Statewide Stroke System was established to ensure patients experiencing signs and symptoms of stroke are quickly identified and routed to the nearest most appropriate stroke center for care.

Activated in October 2017, the Alabama Statewide Stroke System initially launched with three designated stroke center levels I, II, and III, creating a coordinated, statewide approach to stroke care. In March 2022, the system expanded with the addition of Level IIa Stroke Centers, which are thrombectomy-capable and designed to treat large vessel occlusion (LVO) strokes (the most common and severe type of ischemic stroke). This expansion significantly improved access to advanced stroke interventions across Alabama.

The Alabama Statewide Stroke System is a collaborative network of hospitals, emergency medical services (EMS) agencies, the Alabama Trauma Communications Center (ATCC), and the Alabama Department of Public Health Office of Emergency Medical Services (ADPH OEMS) working together to ensure the coordinated delivery of timely, high quality stroke care. Using standardized protocols and the EMSA stroke severity score, patients are routed to the closest available and most appropriate stroke center based on clinical need and hospital capability.

Alabama recognizes four levels of stroke centers to support a tiered system of care:

• Level I Stroke Center --- Provides the highest level of comprehensive stroke care, can treat patients suffering hemorrhagic or large ischemic strokes, including 24/7 specialty coverage, advanced neuroimaging, endovascular and neurosurgical interventions, and intensive care. All Level I Comprehensive Stroke Centers must maintain current certification by a nationally recognized accrediting organization such as The Joint Commission (TJC), Det Norske Veritas (DNV), or equivalent.
• Level IIa Stroke Center (Thrombectomy-Capable) – Specialized hospital equipped and staffed to perform advanced procedures, specifically thrombectomies. A thrombectomy is a life-saving procedure where doctors surgically remove a blood clot from the brain, restoring blood flow and minimizing potential long-term damage from the stroke. These centers have neurologists, neurosurgeons, and specialized equipment available around the clock, ensuring patients receive the fastest and most effective treatment possible to improve their chances of recovery after a stroke.
• Level II Stroke Center – Provides acute stroke evaluation and treatment, including administering intravenous thrombolytic therapy, with established protocols for stabilization and rapid transfer to higher-level stroke centers when advanced interventions are required.
• Level III Stroke Center – Focuses on early stroke recognition, rapid evaluation, and stabilization for timely transfer to a higher-level designated stroke center.

To further support timely access to stroke treatment, the Alabama Statewide Stroke System partners with bordering states Tennessee, Mississippi, Georgia, and Florida to allow cross-border routing and transport when the closest appropriate stroke center is located outside of Alabama.

These coordinated efforts support a unified system of care designed to reduce treatment delays and enhance the delivery of high-quality stroke services across the state.