AHA Code Stroke Alert Level System
The American Heart Association does not publish a standardized, tiered "code stroke alert level system" in their guidelines. Instead, the AHA/ASA recommends that individual hospitals develop their own stroke alert protocols and response systems as part of comprehensive stroke systems of care 1.
What the AHA Actually Recommends
Hospital-Based Stroke Alert Protocols
Institutions should establish written protocols defining processes, responsibilities, and activation criteria for stroke alerts, but the specific structure (including whether to use alert "levels") is left to individual hospital discretion 1.
The stroke response team composition and design varies by institution based on stroke volume, resources, and whether the facility is a primary stroke center, comprehensive stroke center, or other designation 1.
Key Components of Stroke Alert Systems
The AHA emphasizes these elements rather than specific alert levels:
Rapid activation mechanisms that allow any hospital staff member to trigger a stroke alert when stroke symptoms are recognized 1.
Priority dispatch by 9-1-1 systems and EMS personnel for suspected stroke cases, with minimized on-scene and transport times 1.
Liberal approach to activation is recommended, particularly for in-hospital strokes where nonfocal symptoms or confounding factors may obscure the diagnosis 1.
Standardized assessment tools like the National Institutes of Health Stroke Scale (NIHSS) to quantify severity, facilitate communication, and identify candidates for intervention 1.
Quality Improvement Focus
Hospitals should monitor metrics including number of stroke alerts, true stroke rates with subtypes, response times, imaging acquisition times, treatment rates, and outcomes 1.
Multidisciplinary quality improvement committees should review stroke care benchmarks and identify gaps in care delivery 1.
Common Pitfall
Do not assume a universal AHA-mandated alert level system exists. While some hospitals independently implement tiered systems (e.g., "stroke alert" vs. "stroke code" based on severity or time window), these are institutional decisions, not AHA requirements. The AHA framework prioritizes rapid recognition, consistent protocols, and quality metrics over specific alert categorization schemes 1.