DESCRIPTION (provided by applicant): Stroke, seizures, meningitis, anoxic brain injury, traumatic brain injury, spinal cord injury and intracerebral hemorrhage are common neurological emergencies that cause significant morbidity and mortality and result in substantial human suffering and enormous health care costs. Neurological emergencies can be surgical or non-surgical and clinical trials in this area requires a cooperative and coordinated network of emergency physicians, neurologists, neurosurgeons and neurointensivists who can coordinate the pre-hospital, emergency department and inhospital environments to ensure clinical trials for neurological emergencies can be effectively implemented. This proposal, in response to RFA-NS-06-009 for the network hub sites which is a companion to RFA-NS-06-002 for the NETT coordinating center, will describe how we will function as a hub in this network to work in collaboration with the coordinating center. The proposal focuses on how we will utilize the unique skills, relationships and experiences we have as an interdisciplinary team of pre- hospital, emergency and in-hospital providers to recruit, enroll, treat and follow-up patients for proposed clinical trials for patients with neurological emergencies in the pre-hospital environment and at academic and community hospitals within our hub. The first aim of our hub will be to coordinate 2 EMS agencies and seven academic and community hospitals in Santa Clara and San Mateo counties, of which three also provide trauma services to Santa Cruz and San Benito counties. These hospitals and county EMS agencies accounted for over 300,000 ED visits, 6,000 trauma activations and 100,000 EMS responses. All hospitals in our hub have demonstrated a commitment to neurological emergencies by instituting protocols and services to be accredited or in the process of being accredited as JACHO stroke centers. The second aim will be to utilize the expertise of the investigators from Stanford University in emergency medicine and neurological research to extend their clinical research infrastructure and experience to all sites within the hub. The third aim will be to describe how the hub will work with the coordinating center to implement clinical trial infrastructure at these sites. This will be done by partnering with the EMS providers, using innovative systems to identify potential patients, using 24/7 on call support to ensure accurate implementation of protocols and with novel technology strategies to follow-up and retain patients entered into network trials.

The NETT is a research network that allows the efficient implementation of clinical trials involving neurological emergencies. This large interdisciplinary network of providers from academic and community hospitals crosses broad geographic, racial and socioeconomic boundaries to more quickly determine the potential efficacy of new treatments that could reduce the devastation and burden of illness from acute neurological injuries.