Assessment program aims to speed up response time
URBANA – In the space of three hours, you can:
– Bake a small turkey.
– Clean up the house before the company arrives.
– And, quite possibly, minimize the damage done by the most common kind of stroke – that is, if you get to the hospital fast enough.
Three hours is all the time there is to administer a drug treatment for an "ischemic" stroke, the kind that results from a clot in an artery that blocks blood flow to the brain.
And the clock starts ticking at the onset of the stroke.
All too often, precious time is lost because people don't recognize the signs of a stroke and don't go to the hospital, according to Dr. James Ellis, medical director of the emergency department at Provena Covenant Medical Center, Urbana.
That's why Covenant and its sister hospital in Danville, Provena United Samaritans Medical Center, have launched a new stroke assessment and treatment program that starts at the first possible moment, right in the ambulance.
Now, Provena officials say, when an ambulance is called for a possible stroke victim, emergency medical crews serving those two hospitals begin an assessment in the ambulance to determine if the patient is suffering an ischemic stroke and meets the strict criteria for a controversial, clot-busting drug treatment best-known by its acronym, tPA.
The ambulance crew also now starts the patient's IV, gets blood for lab tests and begins documenting findings on a treatment form that is continued by nurses upon arrival at the hospital.
And, to save time, the patient is taken directly to a CT scan at the hospital to confirm that an ischemic stroke has occurred, instead of being taken first to the emergency room, Ellis said.
The two Provena hospitals have set a goal of administering tPA, or tissue plasminogen activator, to patients who meet the criteria for the drug treatment within 30 minutes of arriving at the hospital.
There are about 750,000 strokes in the United States every year, and ischemic strokes account for about 83 percent of them.
The remaining 17 percent of strokes are "hemorrhagic" strokes resulting from a ruptured blood vessel that causes bleeding to the brain, according to the American Stroke Association.
The association advises people to seek medical attention as soon as possible if they think they're having a stroke, and says tPA – approved by the U.S. Food and Drug Administration in 1996 – has been shown to be effective in treating ischemic strokes.
"This makes it very important for people who think they're having a stroke to seek help immediately. If given promptly, tPA can significantly reduce the effects of stroke and reduce permanent disability," the association said in outlining its position on tPA.
It's important to note that tPA isn't a universal cure, doctors say. In fact, it remains a highly controversial treatment among doctors and hospitals because, in some cases, its use can result in death.
About 6 percent of the time tPA is used, it results in a hemorrhage, and if the hemorrhage occurs in the brain it's typically fatal, Ellis said.
So, he added, tPA is only an option when the patient arrives at the hospital on time, meets a strict list of treatment indications, and the stroke damage is serious and not improving.
Dr. Thomas Scaggs, an emergency room physician at Carle Foundation Hospital, says there is also a long list of contraindications in which the drug shouldn't be used – among them recent major surgery or major trauma, pregnancy, any gastro-intestinal hemorrhage within the last three weeks and a blood pressure reading that is too high.
"This is a drug that can kill directly, and that makes it still extremely controversial in our literature," Scaggs said. "TPA is not a miracle drug."
Carle has a stroke treatment system of its own that includes providing a CT scan within 30 minutes of arrival followed by a neurological consultation prior to administering tPA, according to Carle hospital spokeswoman Allison McLaughlin.
Scaggs said Carle waits for the patient to arrive at the emergency room to draw blood, but there haven't been problems with delays.
Carle prefers not to put a door-to-drug time goal on tPA because "this is not a drug you want to cut corners with," Scaggs said.
"We want to be as efficient and fast as possible, but we haven't put time goals per se on it, because personally I think that pushes you to potentially cut corners," he added.
Ellis said the key for the hospital is to both make sure patients meet the strict indications for the drug treatment and meet the critical time frame for administering it.
And to help meet the time frame, the public needs to be better educated about the common warning signs of a stroke, he advises.
A study published last year in the American Medical Association's Archives of Neurology found only 15 percent of patients arrived at hospital emergency departments in time for tPA treatment.