News

Stroke Network to Begin Operations in Calif. County

Jim Steinberg

12/05/2011

Dec. 03--A network of hospitals poised to rapidly deploy the latest techniques to combat strokes is about to begin in San Bernardino County.

Strokes are the leading cause of long-term disability in this country and the fourth leading cause of death.

Every minute a there is a blockage of normal blood flow into the brain means nearly 2 million brain cells die, said Dr. Dan Miulli, stroke center director for Arrowhead Regional Medical Center in Colton.

With participating hospitals geographically dispersed throughout the county, the stroke network is designed to shorten the time appropriate care is delivered to patients, said Dr. Reza Vaezazizi, medical director for the Inland Counties Emergency Medical Agency, which operates and manages an emergency medical services system in San Bernardino, Inyo and Mono counties.

"Right now, all indications are that we will turn the lights on for this program on Dec. 15," he said.

Initially San Bernardino County's stroke network will begin with three participating hospitals: Loma Linda University Medical Center, Arrowhead Regional Medical Center in Colton, and Pomona Valley Hospital Medical Center in Pomona.

San Antonio Community Hospital in Upland, St. Mary Medical Center in Apple Valley and Redlands Community Hospital are expected to join the system next year, Vaezazizi said.

Although located in Los Angeles County, about one-half of PVHMC's patients come from San Bernardino County.

Under the system, emergency medical service providers will take suspected stroke victims to the nearest hospital in the system.

Part of the ICEMA's challenge in setting up the programs was to educate some 1,000 paramedics working in San Bernardino County on the signs and symptoms strokes, Vaezazizi said.

San Bernardino County joins neighboring Los Angeles and Orange County which began similar stroke networks in 2009. Orange County has nine hospitals "up and down Interstate 5 and the 405," said Dr. Samuel J. Stratton, Orange County Emergency Medical Services medical director.

The coverage is good and the system is not looking for new participants, Stratton said.

"It has met all goals and expectations. We are focusing on trying to reduce disabilities from strokes and improving outcomes," he said.

Los Angeles County began its network with nine hospitals, has expanded it to 28 and is still looking for more, officials said.

Pomona Valley Hospital Medical Center is also in the Los Angeles County network.

St. Mary Medical Center, a vital piece in the network to get High Desert coverage, is patching together the needed medical coverage for its stroke center by taping specialists at sister facilities in Orange County, said Dr. James Kyle, vice president for medical affairs.

"We recognize there is a real need in the High Desert," he said. As neurology is among the specialties that is difficult to recruit in the High Desert, St. Mary will use the technology of telemedicine to connect with patients in Apple Valley from sister hospitals in Orange County that are part of the St. Joseph Health System.

Meanwhile, recruitment efforts continue.

Telemedicine devices allow neurologists to conduct exams from a remote locations, by giving instructions to both the patient and a technician who is with the patient, Kyle said.

Before joining the stroke network, hospitals must establish a stroke center and have it certified by either The Joint Commission or the Health Care Facilities Accreditation Program.

For that certification to happen, hospitals must operate a stroke center under stringent guidelines and performance standards. Hospitals are also required to conduct public education programs and train all employees in stroke recognition.

Once certified, a San Bernardino County hospital can apply to 'ICEMA' for admission into the stroke network.

Widespread employee recognition of a stroke can only help speed a patient's movement through the hospital system, from the admissions clerk to the brain scan, which is key to determining what type of treatment will help the patient, said Michelle Nordman, a neuro nurse navigator at San Antonio Community Hospital.

Officials from both Redlands Community Hospital and San Antonio Community Hospital, said they would like to have been part of the first group of hospitals when the county's stroke network goes live, but were delayed because The Joint Commission doesn't have enough inspectors to keep up the demand generated by newly created stroke centers across the country.

Recently, Redlands Community Hospital learned inspectors would be on site Dec. 27, said Kathi Sankey-Robinson, the hospital's vice president for business development and marketing.

San Antonio Community Hospital is hopeful its inspection will be early in January so it can quickly join the network, said Lynn Hill, director of cardiac services.

Sankey-Robinson said it is important for the network to have more hospital participants because of the time limitations on some of the remedies for strokes.

One of Redlands Community Hospital's recent stroke patients was just minutes away from the deadline for administering a drug nicknamed "clot-buster," because it can dissolve an obstruction keeping blood from reaching the brain.

Miulli, ARMC's stroke center director, said many patients with stroke symptoms wait too long before seeking medical attention.

Prior to ARMC initiating its public education programs, stroke victims waited an average of 20 hours before seeking help. Now that time is about 6.6 hours, he said.

Although the improvement is dramatic, it's still well past the deadline for administering that clot-buster drug, he said.

Advances in neuro interventions allow specialized neurosurgeons and neuro interventional radiologists to perform some procedures 12 hours from the onset of the stroke, said Dr. Elia Haddad, director of LLUMC's stroke center.

Deborah Keasler, director of Pomona Valley Hospital's Heart and Vascular Center, said when any of the stroke signs are present, people should call 9-1-1.