Crucial services for stroke patients

Young girl involved in hit-and-run accident in Gilroy

When every second counts, 30 minutes can mean the difference
between a successful recovery and permanent disability or even
death for stroke victims.
When every second counts, 30 minutes can mean the difference between a successful recovery and permanent disability or even death for stroke victims.

The 30-minute ambulance ride to San Jose is a lifetime for someone suffering stroke symptoms, said Wendy Bell, stroke coordinator at Saint Louise Regional Hospital.

“Thirty minutes can make it or break it,” Bell said.

Currently, if a South County resident suffering stroke symptoms – difficulty talking, severe headache, sudden blurred vision, unexplained dizziness or loss of feeling or weakness on one side of the body – calls an ambulance, paramedics will bypass Saint Louise altogether and take them to the nearest stroke center in San Jose, Bell said.

Saint Louise has not been equipped in the past to deal with these cases, due to not having its own neurologists. The hospital will change that when it rolls out a new telemedicine program, the first in the Bay Area, in an effort to offer immediate stroke services to its patients.

After recognizing it was lacking crucial services, Saint Louise teamed up with Specialists on Call, an organization that provides access to experienced, highly-trained specialist physicians from large teaching institutions via video conferencing technology.

Saint Louise will primarily be working with a team of neurologists from the University of California, Los Angeles who are available 24 hours a day, seven days a week, Bell said.

“It’s basically like a high-tech video chat,” said Melissa Lynch, an emergency room doctor at Saint Louise.

Starting in September, treating a stroke victim at Saint Louise will be as simple as calling one of the Specialists on Call neurologists, wheeling a computer console up to a patient’s bed and turning on the screen, explained Heidi Rubin, manager of training and education for Specialists on Call.

During recent training with about a dozen Saint Louise nurses, Rubin showed how well the new technology worked by conducting the session from her office in New Jersey.

After admitting a stroke patient, “You’ll need to go get this wonderful piece of technology,” Rubin instructed the nurses, her voice ringing through one of the hospital’s conference rooms, as clear as a bell.

Using camera controls, the on-call neurologist can conduct a thorough examination of the patient. A high resolution camera allows the neurologist to observe the patient almost as closely as if he were in the same room, Rubin said.

“We can be at that bedside literally in 20 minutes from the time you call us,” she said.

Patients and their families can speak with the neurologist over the computer, and doctors at Saint Louise will then work with the stroke specialists to develop appropriate treatment plans.

“The only thing we cannot do is touch the patient,” Rubin said. “But that’s why we have the nurses.”

Strokes are the third leading cause of death in the United States, according to the American Stroke Association. Santa Clara County’s eight designated stroke centers reported treating 2,528 people for stroke in 2009. In Santa Clara County, strokes are the fifth leading cause of death, with 489 deaths related to stroke in 2007, according to the Santa Clara County Public Health Department.

A stroke occurs when blood vessels in the brain either clog – ischemic stroke – or burst – hemorrhagic stroke. Time is crucial because every minute treatment is delayed, more brain cells may be lost, Bell explained.

When treating ischemic strokes, doctors have a three-hour time window from the onset of stroke symptoms to administer a tissue plasminogen activator, a “clot-busting” drug that can significantly reduce the effects of stroke and reduce permanent disability, according to the American Heart Association. The drug is often used to treat heart attacks as well.

While three hours may seem like plenty of time to get to the hospital, many stroke victims, especially elderly ones, don’t immediately recognize their symptoms as those of a stroke, Bell said.

“They think they’re just not feeling well or that their symptoms will go away. Or they’ll wait until one of their children can come get them,” Bell said. “That’s really cutting that three-hour time window down.”

Another 30 minutes spent in the back of an ambulance only makes matters worse.

“That’s a longer transport time for the patient. (The patient) is out of the community and not with the doctors that are used to taking care of them,” Lynch said. “So we’re really happy to be able to have this capability.”

During the next month, Saint Louise will hold a series of stroke education classes for its employees, followed by health fairs for the community.

“I think this is going to open the door for all kinds of possibilities,” Bell said.

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