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Last year, ECHN’s Manchester Memorial Hospital and Rockville General Hospital received Advanced Certification as Primary Stroke Centers by the Joint Commission. This certification means that both hospitals have demonstrated that they each have a designated stroke unit for the acute care of stroke patients, utilize clinical practice guidelines provided by the American Heart Association/American Stroke Association, and have designated practitioners knowledgeable in the diagnosis and treatment of stroke and who are responsible for responding to patients with an acute stroke 24 hours a day, seven days a week. This certification also assures that both hospitals have core stroke team members who receive dedicated stroke education annually, provide annual stroke education to the public, and collect, analyze, and use data to continuously improve the care, treatment and services provided to stroke patients.
For patients, it means fast care close to home when 9-1-1 is called. “When we respond to a call and get to the scene, we immediately assess the patient. If they are showing stroke-like symptoms, we immediately load them into the ambulance and we look to bring them to the nearest primary stroke certified facility,” explains Melissa Osborne, paramedic for Ambulance Service of Manchester. “We call the hospital en route and notify them that we have a possible stroke patient.”
“At ECHN, the ambulance crew radios to us that a possible stroke patient is coming in and a notification goes out throughout the hospital to assemble the Emergency Department stroke team as well as other areas including the lab and radiology,” explains James Castellone, MD, MBA, FACEP, Vice-Chair, Medical Director for ECHN’s Department of Emergency Medicine and EMS Medical Director. “When the patient arrives in the ED, there is a stop at triage for a quick assessment and then he or she is brought immediately to CT-Scan. The CT-Scan is being done to rule out other causes for the stroke symptoms.”
A stroke occurs when a blockage stops the flow of blood to the brain. When this happens, the brain does health education programs continued not get enough oxygen or nutrients, which causes brain cells to die.
Strokes need to be diagnosed and treated as quickly as possible in order to minimize brain damage.
“Once the patient has the CT-Scan, they return to the ED where any further medical stabilization that may be needed takes place. We also connect with the neurologist at Yale New Haven Hospital and utilize teleneurology, or video communication, to further assess the patient, view the CT-Scan images and determine the appropriate treatment for the patient. Teleneurology services are available at ECHN 24-hours a day, seven days a week,” says Dr. Castellone.
Provided there are no contraindications, and the patient is an appropriate candidate, the recommendation is often to administer the clot-busting drug known as Alteplase, which has been shown to be effective for patients whose symptoms have been going on for up to four and a half hours. There is more risk of bleeding complications after four and a half hours, which is why it is so important for patients with stroke-like symptoms to get emergency care immediately. The faster you can restore blood flow to an area, the more brain cells you can save, and the better the recovery. Sue Malone, Administrative Director of Patient Care Services at ECHN explains that “after a patient receives Alteplase, he or she is brought up to the ICU where vital signs and neuro-status are closely monitored. The goal is to treat the patient quickly; the faster we treat the patient the more likely the patient will turn around and return to their normal status.” “It’s great to see a patient come in needing critical care and then they are able to leave right out the front door. As caregivers that’s what we strive for every day.”
FAST is a simple way to remember the main symptoms of stroke. Recognizing these symptoms helps you know when to call for medical help. FAST stands for:
»» Face drooping.
»» Arm weakness.
»» Speech difficulty.
»» Time to call 9-1-1.
If you have symptoms of a stroke, call 9-1-1 or other emergency services right away.