Neurological emergencies comprise a wide range of conditions which include refractory seizures, acute stroke, traumatic brain and spinal cord injury, meningitis and encephalitis, hypoxic-ischemic encephalopathy, and acute neuromuscular conditions. While these may initially appear to represent disparate conditions, they share two important characteristics: earlier treatment is likely necessary to improve patient outcome and logistics of initial patient presentation pose major challenges to clinical trials of treatments fo these conditions. The NINDS Neurological Emergencies Treatment Trials Network has created a national network of hub and spoke hospital systems to facilitate the conduct of streamlined clinical trials for neurological emergencies such as these. SF-NETT: the San Francisco Neurological Emergencies Trials network has been a high-enrolling hub-spoke system during the first 5-year NETT cycle. SF-NETT represents a scalable and flexible network which can be configured and activated to maximize enrollment of eligible patients across a wide range of conditions being studied. Consisting of all San Francisco ambulance destination hospitals, as well as three specially selected geographically non-contiguous spokes (UCSF-Fresno, Queen's Medical Center, and UC Davis), SF-NETT represents a consortium of academic and community hospitals with a catchment population exceeding 4 million. San Francisco General Hospital is a trauma center, stroke center, the SF-EMSA base hospital, and serves as the hub of SF-NETT. Between the hub and participating spoke hospitals, there are 4 designated trauma centers, 7 comprehensive stroke centers, and 4 EMS systems. SF-NETT works directly with NINDS and the NETT Clinical Coordinating Center to conduct multiple concurrent clinical trials of neurological emergencies via the network, with four trials initiated (one completed) during the initial 5-year cycle. This application is for the 5-year renewal of SF-NETT as a hub for the national NETT network.

Public Health Relevance

Neurological emergencies such as refractory seizures, stroke, and neurotrauma have a major impact on public health and are the challenging conditions to study because of the need for early intervention. The NETT network has proven to be an efficient system in which to conduct these trials and SF-NETT has been a high-enrolling active hub during the initial 5-year program cycle.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Cooperative Clinical Research--Cooperative Agreements (U10)
Project #
Application #
Study Section
Special Emphasis Panel (ZNS1-SRB-N (01))
Program Officer
Janis, Scott
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Francisco
Schools of Medicine
San Francisco
United States
Zip Code
Claude Hemphill Iii, J (2017) Improving Outcome After Intracerebral Hemorrhage: Maybe It is the Body, Not the Brain. Neurocrit Care 26:157-159
Chan, Sheila; Hemphill 3rd, J Claude (2014) Critical care management of intracerebral hemorrhage. Crit Care Clin 30:699-717
McMullan, Jason T; Jones, Elizabeth; Barnhart, Bruce et al. (2014) Degradation of benzodiazepines after 120 days of EMS deployment. Prehosp Emerg Care 18:368-74
McMullan, Jason T; Pinnawin, Ashley; Jones, Elizabeth et al. (2013) The 60-day temperature-dependent degradation of midazolam and Lorazepam in the prehospital environment. Prehosp Emerg Care 17:1-7
Ginsberg, Myron D; Palesch, Yuko Y; Hill, Michael D et al. (2013) High-dose albumin treatment for acute ischaemic stroke (ALIAS) Part 2: a randomised, double-blind, phase 3, placebo-controlled trial. Lancet Neurol 12:1049-58
Nakagawa, Kazuma; Vento, Megan A; Seto, Todd B et al. (2013) Sex differences in the use of early do-not-resuscitate orders after intracerebral hemorrhage. Stroke 44:3229-31
Hemphill, J Claude (2013) It's getting better all the time? Using secular trends to understand the impact of neurocritical care. Intensive Care Med 39:1489-91
Silbergleit, Robert; Durkalski, Valerie; Lowenstein, Daniel et al. (2012) Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med 366:591-600
Hemphill, J Claude; Andrews, Peter; De Georgia, Michael et al. (2011) Multimodal monitoring and neurocritical care bioinformatics. Nat Rev Neurol 7:451-60
Nakagawa, Kazuma; Hills, Nancy K; Kamel, Hooman et al. (2011) The effect of decompressive hemicraniectomy on brain temperature after severe brain injury. Neurocrit Care 15:101-6

Showing the most recent 10 out of 17 publications