EMS, Hospitals Working Toward Quicker Treatment in Stroke Care

Aug. 26--When a person is having a stroke, every second can result in millions of brain cells dying. The more time that passes before a person gets help, the more likely he or she will be paralyzed, suffer from brain damage or other stroke-related conditions.

Strokes, which can be caused by a blocked artery or a blood clot, cut off blood to the brain, depriving it of critical oxygen and valuable nutrients. And even if patients are administered the clot-busting drug tPA or treated with clot-busting devices within a three- to four-hour window, only about 30 percent will see their conditions improve, medical experts say.

"Time is very important when it comes to stroke care," said Felipe de los Rios, medical director for the Comprehensive Stroke Center at Baptist Health Neuroscience Center.

In recent years, hospitals, EMS officials and the American Heart Association/American Stroke Association have stepped up efforts to reduce the time it takes from when a person exhibits signs of a stroke to the time they are treated. The universal goal is for EMS personnel to recognize stroke symptoms including slurred speech, face drooping and arm weakness, and call a stroke center so that a team is ready when the patient arrives at the hospital.

Among the local efforts:

--Baptist Health South Florida has taken a multidisciplinary approach that has reduced "door to needle time" by 50 percent over the last year.

--The Fire Officers Association of Miami-Dade County along with 16 stroke centers across the county have formed the Miami-Dade Stroke Consortium to have a systematic approach to stroke care. The group also gets input from neurologists and neuro-interventional radiologists to help with its mission to improve stroke care.

--The University of Miami maintains the Florida Puerto Rico Stroke Registry, a database that tracks stroke care and outcomes at participating hospitals, as part of the Florida Puerto Rico Collaboration to Reduce Stroke Disparities. The database is a centralized spot so that hospitals can gauge where they stand when it comes to other hospitals.

--The Broward EMS Stroke Coalition has been working on standardized EMS and in-hospital protocols, to achieve the best outcomes possible for stroke patients. The group meets quarterly.

Earlier this month, the Broward Coalition organized a Tri-County Stroke Collaboration to get EMS and hospital personnel from Miami-Dade, Broward and Palm Beach counties on the same page regarding stroke care and push for more accountability for stroke centers. While the the American Heart Association/American Stroke Association has set some standards for care dubbed Get with the Guidelines, the coalition wants to stress data collection to force accountability.

Dr. Brijesh P. Mehta, medical director of stroke and neurocritical care at Memorial Healthcare and a neurointerventional surgeon, has been pushing for more collaboration because "collaboration means better treatment."

"A delay in treatment can have devastating results," he said.

Ed's Note: Dr. Mehta, along with Dr. Peter Antevy and Fire Chief Mark Ellis, will present a free webinar on Wednesday, August 31, and a 4-hour workshop on Tuesday, October 4, at EMS World Expo in New Orleans, LA, on how EMS agencies can build an effective stroke system of care.

Strokes rank fifth in U.S. deaths and represent the second cause of disability in the United States.

Mehta said a person's chances for a better outcome improve the faster a blood clot is broken.

"Every 30 minutes results in the likelihood of a good outcome decreasing by 18 percent," he said.

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