A mobile stroke treatment unit (MSTU) operated by Cleveland Clinic which uses telemedicine to connect emergency team members to a hospital-based vascular neurologist, reduced time to tPA treatment by more than 25 minutes in an analysis of the first 100 patients transported. ...
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| Photo by Chris Violette via Flickr |
Patients suspected of having a stroke should be transported to an accredited comprehensive stroke center (CSC) when it is reasonable to do so, they wrote. When a CSC is too far away, patients should be taken to the nearest primary stroke center (PSC) that is linked to a CSC by telemedicine. They also called for the expansion of telemedicine networks linking smaller, non-PSC hospitals in very rural communities to accredited stroke centers.
"The qualifications for these PSCs and CSCs should be upgraded so that imaging technology and the availability of neurologists to see patients 24/7 should be requisites," the editorialists wrote. "Systems for rapid imaging and throughput should be in place at these centers."
Arkansas is ranked No. 1 for stroke deaths in the country.
"A physicians shortage is a big part of it," said Northwest Medical Center Emergency Medical Director Dr. Katherine Barton. "Unfortunately, some parts of our state are very poor. There's just not always enough access to physicians like people need. There's not education about strokes that we need to have out there. And there's a lot of cardiovascular disease in our state because of a lot of obesity and smoking."
When it comes to strokes, time is everything.
"The more time that passes, the more damage that's done, the more brain cells that die and the more of your function you cannot get back," said Barton.
Hospitals in outlying areas, such as Ocean Beach Hospital, do not have a neurologist on staff who could make an assessment within this critical window, and that's where the telestroke robot comes in.
The robot allows neurologists to beam in live to the emergency department to perform real-time examinations and evaluations of stroke victims. With the remote-controlled robot, equipped with cameras and microphones, consulting doctors can review charts, patient records, diagnostic images such as CAT scans and talk directly to ED physicians, the patient and the patient's family.
"Basically, it's just like having the neurologist right in the room," said Valerie Mays, Providence's telestroke program coordinator.
Providence neurologist, Nicholas Okon says many rural clinics don’t have a team of stroke experts, and flying a patient by helicopter or driving by ambulance takes time.
Nicholas Okon: “There’s only one FDA approved treatment for a stroke, and it’s an IV medicine that has to be given within three hours of the stroke symptoms beginning. So if they present to a facility that doesn’t have a neurologist or expertise in providing this medicine, they may not have that opportunity.
Experiences such as those are why the Mayo Clinic physician and others see telemedicine as one solution to a vexing problem: Few stroke patients are getting emergency treatments that sometimes prevent the most devastating effects of strokes.
One big reason is that far too few do what that Arizona woman did: Get to a hospital immediately. The most widely used treatment is a clot-busting drug called tissue plasminogen activator (tPA) and, under current guidelines, it must be given within three hours of the first symptoms.
Stroke patients treated at community hospitals with specialized stroke care and telemedicine support from major stroke centers are more likely to survive and live independently than patients treated at hospitals without stroke units, a German study finds.
t's vital to get stroke patients to the right place or in communication with the right people. Ideally both. This can be crucial in the outcome of a stroke.
