Experts propose ways to reduce time in treating stroke - MyCentralJersey.com

Experts at JFK Medical Center in Edison propose innovative new measures to help physicians and EMS practitioners further streamline the treatment of stroke

Fact: Americans suffer approximately 800,000 new strokes per year - about 15 percent to 20 percent of them are fatal - and stroke is the No. 1 cause of disability in the United States.

Caused by a loss of or restriction in blood flow to the brain (often driven by such risk factors as diabetes, hypertension, obesity, etc.), stroke can affect people of all ages and lead to disabling impairments that can reduce quality of life for both victims and their loved ones/caregivers.

For a condition in which every moment counts and in which quicker access to treatment can significantly reduce or even reverse a stroke's impact, experts at JFK Medical Center are proposing innovative new ways to further streamline the administration of treatment to stroke victims between the point of patient location and the hospital and are lobbying for the more broad-based adoption of these beneficial practices, especially as World Stroke Awareness Day this week shines a spotlight on this devastating disease.

Access to the antidote

'We've made enormous headway in the treatment of stroke within the first few hours by reversing it with the FDA-approved clot-busting drug known as t-PA (Activase), and New Jersey's Stroke Center Act of 2004 created a network of stroke centers in the state qualified to administer t-PA, but the battle is administering it in time,' shared Martin Gizzi, chairman of JFK's Neuroscience Institute, Chairman of the Stroke Advisory Panel for New Jersey's Department of Health, and Chairman of the Northeast Cerebrovascular Consortium, an affiliate of the American Heart Association. Because the absence of blood flow to the brain results in the ongoing death of brain cells and continued loss of functionality, 'every minute of delay in administering t-PA is worth 1.8 days of disability-free life,' he said. 'Years ago, we were treating 4 percent of patients nationwide with t-PA, which has grown to 8 percent and even 10 percent in New Jersey thanks to greater awareness by both hospitals and patients. But with a theoretical goal of administering it to 30-40 percent of all stroke patients someday,' he said, 'we've got a long way to go.'

To help close that gap, Gizzi advocates further streamlining the process by which stroke victims are treated during transport to the hospital through a series of new practices, many of which require a physician's greater trust in, reliance on, and collaboration with the EMS personnel and paramedics who are first on the scene. Among Gizzi's recommendations are:

* Preparations En Route - Gizzi advises that stroke victims be transported to a hospital via ambulance rather than being driven in a car, as studies show that 'those transferred by EMS are more likely to be treated with t-PA,' he said. Among the several things that EMS personnel can do in the field to prepare patients for immediate treatment with t-PA upon arrival at the hospital include bringing the victim's blood pressure into the right range based on recently-published guidelines for this. 'Drawing blood is another area of opportunity,' Gizzi noted. 'Paramedics are already putting IV lines into patients and getting access to their veins on the way, so having them draw a blood sample and hand it to attending physicians when they arrive at the emergency department saves critical minutes.'

* Door-to-Drug Procedures - 'For stroke victims at JFK, we have a door-to-drug target of 60 minutes for stroke patients and have reduced that to 45 minutes, but there are ways for medical teams to reduce that time-line even further,' Gizzi said. 'In the past, EMTs would call us in advance to say they were coming with a stroke victim and we would meet them at the hospital door, unhook the patient's wires, put them on a bed in the emergency department, and take them for a CAT scan, which was a 10-to-15-minute process. Now we're preparing to meet them at the door, keeping the patient on the stretcher, and moving them right to the CAT scan,' he said. 'This hands over more authority to prehospital providers, but we've found that they're delighted to be part of the continuum of care and that patients benefit from the valuable time savings.'

Martin Gizzi, Chairman of JFK's Neuroscience Institute, Chairman of the Stroke Advisory Panel for New Jersey's Department of Health, and Chairman of the Northeast Cerebrovascular Consortium, an affiliate of the American Heart Association' (Photo: PHOTO COURTESY OF JFK MEDICAL CENTER )

* Point of Care Testing - Gizzi said that paramedics can remove another 30 minutes from the treatment process for some patients by providing a reading of point-of-care blood coagulation values, an activity that requires as much as 45 minutes in the lab.

Overall, said Gizzi, 'it's about allowing the EMS community to fully prepare patients for the treatment which appears to be appropriate.' And while he acknowledges that some doctors are concerned that this may be vesting too much authority in a team of non-physicians, 'these are professional services, transport nurses, and paramedics who are extensively trained to deliver advanced life support and make important treatment decisions,' he said. 'While we of course want to always respect a medical professional's clinical judgment, we also want to recognize the EMS practitioner's knowledge and skill and use it to benefit our patients.'

Mark Bober, clinical manager for JFK's Emergency Medical Services division, agrees. Overseeing a team of approximately 150 EMTs, paramedics, and specialty care transport nurses and a fleet of 6-8 basic life support ambulances and 4 advanced life support units which receive as many as 75,000 requests for 911 responses annually, Bober confirmed that 'numbers and time really matter with stroke patients and their care requires a lot of collaboration - everything needs to happen as quickly and accurately as possible in these situations.' Currently promoting a '10 minutes on scene' target, 'we train our team to treat stroke victims like trauma patients - we can't fix their specific problem in the field and they ultimately need a skilled physician, but there are certain things we need to accomplish on the way,' he said. 'Cutting-edge stroke centers are increasingly empowering prehospital providers to deliver the best possible care en route, which is a responsibility we take very seriously. At the same time,' he added, 'we enjoy knowing what happens with patients we've cared for and closing the educational loop. We're not just a ride to the hospital, but the first step in a highly orchestrated process and a critical part of the continuum of care team.'

Gizzi reminds people of the importance of stroke prevention by reducing risk factors - such as refraining from smoking, eating a healthy diet, getting adequate exercise, maintaining a healthy weight, keeping blood pressure, cholesterol, and other vital measures in a healthy range, etc. - as well as understanding signs of the condition. 'Should stroke actually occur,' he said, 'people need to recognize and appreciate that treatment begins right in the field with EMS personnel.'

Based on JFK's progressive practices involving the treatment of stroke victims, 'as many as 20 percent of our stroke patients are receiving t-PA and we hope to see that number double,' Gizzi said. 'But in the last nine years, we've seen stroke fall from the number 3 killer in the U.S. to the number 4 killer, so we're headed in the right direction.'

In the event of a stroke, people are encouraged to remember the acronym 'FAST':

* 'F' is for Face - does one side of their face droop?

* 'A' is for Arms - when raising their arms, does one arm drift downward?

* 'S' is for Speech - is their speech slurred or strange?

* 'T' is for Time - it's time to call 9-1-1 immediately if you observe any of these signs

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Entities 0 Name: Gizzi Count: 9 1 Name: EMS Count: 7 2 Name: JFK Count: 5 3 Name: Stroke Advisory Panel for New Jersey 's Department of Health Count: 2 4 Name: New Jersey Count: 2 5 Name: Martin Gizzi Count: 2 6 Name: Northeast Cerebrovascular Consortium Count: 2 7 Name: American Heart Association Count: 2 8 Name: JFK 's Neuroscience Institute Count: 1 9 Name: Neuroscience Institute Count: 1 10 Name: U.S. Count: 1 11 Name: United States Count: 1 12 Name: Mark Bober Count: 1 13 Name: JFK Medical Center in Edison Count: 1 14 Name: Emergency Medical Services Count: 1 15 Name: Bober Count: 1 Related 0 Url: http://www.take2forstroke.com/ Title: Covidien | World Stroke Day Description: Someone suffers a stroke every other second - regardless of age or gender. Every six seconds, stroke claims a life. It's critical that we give a greater voice to stroke. This year, on World Stroke Day, we need your help to raise awareness about this disease.