Mock Stroke Incident Shows Mo. Hospital`s Treatment Capabilities

Oct. 07--WARRENSBURG -- A mock incident gave community members a dramatic look at stroke patient treatment at Western Missouri Medical Center's new Level III Stroke Center.

Johnson County Ambulance District and hospital personnel provided the scenario at the end of Alissa Karnes' presentation on Pathways' new apartment and office complex on Burkarth Road. She spoke to the Community Leadership Involvement Means a Better Community, or CLIMB, class.

The exercise started when class member Shawnda Conner, hospital radiology director, went limp in her chair. She shook her head "no" when asked if she felt OK.

Other class members -- obstetrics department manager Amy McCartney and pharmacy director Seth Hall -- unaware of the exercise, rushed to her side. Hall asked Conner questions about her physical condition, risk factors and medical history. McCartney placed a 911 call to Central Dispatch.

Other class members stood in shock.

Paramedic Randall Ermer and EMT Tommy Edwards arrived by ambulance. They relayed Conner's condition to Central Dispatch and the hospital, loaded her onto a stretcher and transported her to the hospital, where the stroke team waited.

Bused to the hospital after learning Conner faked the stroke, the class followed her to radiology where a CAT scan is thefirst step in determining the type of stroke.

Still on the stretcher, Conner and the class then went to the emergency room. Nurses simulated hooking her to machines that monitor vital signs.

Dr. Simon Clark, emergency room medical director with EmCare, said scan results -- to find whether the stroke involved bleeding or a clot -- usually would arrive in two to three minutes.

Ambulance personnel would check whether a helicopter could take Conner to a facility for more advanced treatment, he said. The original scenario included LifeFlight, but rainy weather grounded the helicopter.

Clark said ambulance personnel would stay on scene in a real emergency to transport the patient if a helicopter could not.

Ambulance district Chief Shane Lockard said paramedics would assess the patient. If suspecting a clot, they can take the patient to the hospital to receive clot-busting drugs.

In the first 10 minutes of arrival, a nurse and doctor compare stroke scales that show the extent of neurological deficit, Clark said.

Based on radiology and blood test reports, the physician decides whether to use a clot-busting drug, he said. The decision is the most important made within the first hour of the patient's arrival.

If there is a question about using the drug, Clark said, then a neurologist at St. Luke's or the hospitalist on duty can be called.

"We want to give it as quickly as possible," he said.

There is about a three-hour window to use the drug.

After initial treatment, the patient goes to a facility offering higher-level stroke care.

If the patient cannot be treated with the tPA drug, the advanced care facility may be able to retrieve the clot, but the benefit of retrieval "is not as well defined as tPA," Clark said.

"The initial step in the emergency room is the most important," he said.

ICU director Dain Sisk said that, before the hospital received the Level III Stroke Center designation, the ambulance took a patient directly to another facility. Lockard said Lee's Summit is the closest for stroke treatment.

Hospital Director of Marketing Tara Carlyle said the Level III designation is important.

"We have all the procedures in place so we can do life-saving procedures here as quickly as possible," she said.

Class members said the fake stroke shook them, but the treatment process impressed them.

"I was definitely shocked and surprised. ... I'm thankful we were quickly told it was a drill," Beth Stuart said, adding, "They clearly do a great job. It's good they have the (Level III) designation."

"They acted quickly and very efficiently," hospital employee Stephanie Truex said.

Carlyle said Conner played the victim well.

"People took it seriously. They truly thought it was real. ... It was reassuring (hospital personnel) jumped in as quickly as they did. ... They were quick to call 911 and answered the questions appropriately," Carlyle said.

The ambulance arrived quickly, Caryle said, and emergency room personnel "jumped in."

"I'm glad we were able to show our resources and how we can respond to a stroke," she said.

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