AcuteCare Telemedicine Blog

EMS Role is Critical to Stroke Treatment and Recovery

Each year, almost 800,000 Americans suffer a stroke, on average one American suffers a stroke every 40 seconds and one victim dies every 3 to 4 minutes making stroke the third leading cause of death in this country, after heart disease and cancer.

Innovations in the treatment of stroke have provided many new options for physicians and emergency room personnel over the past half-decade, but getting the stroke victim to the most effective treatment center still remains a critical element in a victims long term survival. EMS is a part of the success of any telemedicine program. Being able to quickly assess a patient to identify acute stroke symptoms is one thing – getting the patient to the closest most equipped hospital is another. Hospital associations and telestroke providers need to include EMS in the conversation as it will dramatically impact the lives in acute stroke events.  EMS teams must have a goal of getting potential stroke victims stabilized, evaluated, and to a primary stroke center in less than an hour.

To plan for an effective response, directors of EMS units should have a preplanned stroke protocol written for their teams, divide the EMS unit’s region into districts according to the nearest emergency department capable of treating acute strokes and maintain regular training sessions for EMS personnel.

The Utah Department of Health and The Bureau of Emergency Medical Services are leading the way in establishing effective procedures and communications to EMS personnel when it comes to transporting patients for the treatment of stroke. The Bureau has identified eight regional hospitals throughout the state as “Primary Stroke Centers”, hospitals that have undergone certification by the Joint Commission or DNV as specialized centers providing the highest level of comprehensive stoke care. This includes advanced time-critical emergency stroke care, including specialized radiology, neurology, and neurosurgery expertise, as well as complete inpatient treatment and outpatient rehabilitative programs for stroke patients.  In addition, 17 localized hospitals have been designated as “Stroke Receiving Facilities”, centers that have procedures, equipment, and protocols in place to provide time-critical emergency stroke care, in consultation with one of the Primary Stroke Centers.

For stroke victims, there is less than 4.5-hours after the onset of symptoms in which thrombolytic therapy offers an enhanced opportunity for a patient’s recovery.  Educating and training EMS and First Responders to identify, properly evaluate and transport victims to a Primary Stroke Center, or a Stroke Receiving Facility, is critical to the successful outcome of treatment for stroke victims.

AcuteCare Telemedicine and Ty Cobb Regional Medical Center Team Up to Improve Access to Immediate Stroke Care

Throughout Georgia and all around the country, Emergency Medical Services (EMS) responders are charged with reacting to emergency calls for assistance, providing emergency evaluation and treatment of a vast array of injuries and illnesses and delivery victims to emergency rooms for more advanced treatment.

The work requires split-second decisions that may affect the patient’s recovery.  Often the decision to bypass the nearest, more rural hospital for an urban medical center, known for its specialized treatment for such illnesses as stroke, can delay the patient’s arrival to that facility beyond the “golden hour”, the first sixty minutes after a patient begins to experience stroke symptoms and the critical window for providing care that can minimize long-term disabilities or prevent a stroke death.

At a recent conference at Ty Cobb Regional Medical Center (TCRMC) in Lavonia, GA, area EMS responders learned of a new program at the hospital that offers advanced critical, specialized care for victims of stroke. The goal was to educate emergency responders about its new telestroke program and how it can benefit the community, and TCRMC by capturing potential stroke patients that may have been otherwise bypassed by EMS personnel in the past.

The new teleneurology/telestroke program is a relationship between TCRMC and AcuteCare Telemedicine (ACT), a leading practice-based provider of Telemedicine services for hospitals seeking advanced around-the-clock stroke and other urgent Neurological care.  Presenting the conference was Dr. David Stone, TCRMC Emergency Room Director and ACT’s CIO Dr. James M. Kiely, who is also partner at Atlanta Neurology, P.C. and Medical Director of the Neurophysiology Departments at Northside Hospital and St. Joseph’s Hospital of Atlanta.

Members of the Franklin County and Hart County EMS were on hand to receive information about the new service line and EMS’ role in triaging potential stroke patients.  “The goal of this new relationship with TCRMC is to build awareness in the area about ACT’s 24/7 stroke treatment coverage and to advance the area residence understanding of stroke, its symptoms and the importance of receiving immediate specialized treatment, said Dr. Kiely.”

Attending EMS personnel received information regarding strokes “golden hour”, and when it is appropriate to take patients directly to TY Cobb Regional Medical Center or when it is better indicated to take patients directly to an advanced tertiary treatment center.

Recent studies indicate that telestroke programs, like the one provided by AcuteCare Telemedicine, may improve access to immediate stroke care by 40 percent and bring advanced care within reach of millions of stroke victims now located outside the hour of critical care for the fourth most common cause of death in the United States.

Telemedicine in the Wake of Natural Disaster

As October 2012 came to a close, the arrival of Hurricane Sandy served as a haunting reminder that we can never underestimate the destructive and disruptive power of nature. The “superstorm” wreaked havoc on some of the most populous areas in the United States, not just causing billions in physical damage, but severely testing our infrastructure and its vital role in our society.

Considering the major implications that storms or other disaster events on this scale have for the healthcare industry, the days leading up to, during, and following Sandy were a demanding exercise in preparation, planning, and execution. The storm left countless citizens in need of medical attention, and threatened the adequate treatment of those already receiving care.

As one major resource put under the stresses of a disaster-level storm, hospitals and other healthcare facilities quickly became incapacitated by overcrowding, understaffing, a broken supply chain, and in select cases, power failures that crippled essential equipment. A small contingency of Mobile ERs were dispatched across the region, but a lack of pure manpower hindered the effectiveness of the efforts. Despite their mobility, the interrupted transportation systems within the affected communities prevented many from reaching the help they sorely needed.

Telehealth is an ideal candidate for addressing the challenges of these kinds of circumstances. The infrastructure of telemedicine is capable of delivering expert direction and attentive care to victims of natural disasters. The question of manpower becomes a negligible issue, as doctors and other respondents can call in from anywhere, and thanks to ever increasing internet access, the reach of the care administration is not limited by the victims’ location.

If emergency management agencies and telecommunications service providers are willing to work hand in hand with healthcare professionals, we now have the tools and knowledge to ensure that in future disaster scenarios, people can always have the support they need.