Rapid treatment aims to save lives and improve recovery
Advances in stroke treatment have made it possible to save more lives and protect more patients from permanent disabilities. However, timing is critical. For these powerful treatments to enhance recovery, they must be given to patients as quickly as possible.
The University of Alberta Hospital (Alberta Health Services) in Edmonton is launching a ground-breaking initiative to help reduce the time between a stroke’s onset and treatment for greater numbers of people in its service area.
In early 2017, the hospital will start operating its new stroke ambulance – putting its diagnostic and treatment expertise “on the road” to provide vital, timely treatment for stroke patients in small communities farther from the city. This three-year pilot project will be the first stroke ambulance in Canada and the first in the world to provide stroke patient care outside the limits of a large urban centre.
“We will be able to dispatch the ambulance to rural areas and, if appropriate, treat patients right inside the vehicle as we transport them to our hospital,” says Dr. Ashfaq Shuaib, director of the hospital’s stroke program.
The University Hospital Foundation has committed to raising $3.3-million for the project, which includes building and equipping the specialized vehicle, operations, and a study of health and economic impacts.
“Every minute that you are having a stroke, you lose about two million brain cells,” explains Dr. Shuaib. “And there is a finite time window in which you can effectively treat the patient with clot-busting drugs – 4.5 hours. To use these drugs, we must be certain that the stroke is not because of a hemorrhage, and the only way we can know is to take a CT scan.”
Most strokes are “ischemic” – caused when a clot blocks an artery supplying blood to the brain. A “hemorrhagic” stroke involves bleeding in the brain. If the clot-dissolving drug called tissue plasminogen activator (tPA) is given to a person having a hemorrhagic stroke, the results can be fatal.
That is why the stroke ambulance will be equipped with a mounted, portable CT scanner to allow that vital identification of the type of stroke. Also on board will be lab equipment, medication and an advanced video conferencing system connecting the patient and staff on the vehicle with a neurologist at the hospital. This larger-than-normal ambulance will be able to hold EMS personnel, a CT technologist, a nurse and other medical personnel.
The vehicle will also will be customized for the rural areas it will traverse.
The technology will be designed to work in isolated locations with potentially spotty Internet connection, explains Shy Amlani, program manager for Alberta Health Services’ stroke program, in Edmonton and the surrounding area. “It is also being designed for winter in northern Alberta, where many rural side roads have varying terrain. To work, the scanner must be level, so the ambulance has a self-levelling mechanism.”
The hospital will study the stroke ambulance outcomes to assess the improvements to patient lives and the potential economic savings to the health-care system.
“Stroke is more likely to result in disability than cause death,” says Dr. Shuaib. “Less than 10 per cent of patients recover fully, and one-third to one-half are severely disabled. If someone cannot be treated within the crucial window – and they are disabled and require nursing care – the cost is around $100 thousand for six months.”
“If we can treat stroke faster and change the level of disability the individual has from major to minor, it can save the health system about $1-million over their lifetime,” adds Amlani.
“We’re excited that we have the potential to increase quality of life for those individuals who live farther away from stroke care. And grateful to the generous donors who are making it possible.”
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Act FAST when stroke symptoms appear
Quick medical intervention for a person having a stroke greatly increases their prospects for an eventual return to their pre-stroke quality of life.
It is crucial that people recognize the signs of stroke because “every minute counts,” stresses
Dr. Ashfaq Shuaib, director of the stroke program at Edmonton’s University of Alberta Hospital.
“Too often, people don’t seek immediate help because stroke symptoms are ‘negative.’ Unlike a heart attack, which is often very painful, stroke involves a loss of function, such as difficulty speaking.”
Experts urge people to remember the acronym FAST:
Face – Is it drooping?
Arms – Can you raise both?
Speech – Is it slurred or jumbled?
Time – Time to call 9-1-1 right away.