21 Sep 2013 Acting FAST can save lives
by Sonja J. Keith
Nancy Elphingstone knew minutes and hours were crucial after she began suffering stroke-like symptoms. Fortunately, she acted “FAST.”
On Jan. 2, Elphingstone, 63, was taking her time before beginning the morning drive from Conway to Little Rock and her work as executive director of the HomeCare Association of Arkansas. All that changed when she began experiencing loss of motor control in her right arm, along with numbness in her right arm and leg and dizziness. “I could walk on it but didn’t feel I could trust it,” she said, adding that she called a neighbor who took her to the Conway Regional Emergency Department.
After a CT scan, Elphingstone remembers nurse Shannon Golden holding her chart and checking criteria for a stroke. A neurologist in Fort Smith received the information via AR SAVES digital imaging and recommended that she take a clot-busting drug.
“Everybody was on their toes; she (Golden) was online immediately. I actually talked to the doctor in Fort Smith,” said Elphingstone. “They were very quick, and I got the drug. The nurse held it up to the camera and told me I would be going to UAMS.”
According to Michael Manley, director of AR SAVES and outreach at the UAMS Center for Distance Health, SAVES (Stroke Assistance through Virtual Emergency Support) presents an innovative solution to a statewide problem of stroke mortality. “Without sub-specialty support of a vascular neurologist, many rural emergency rooms treating the potential stroke victim are reluctant to diagnose stroke and administer the clot-busting medication,” he said. “Utilizing cutting edge video technology, we are able to bridge that gap of care and take care of the patient closer to home for the best outcomes.”
Conway Regional trauma coordinator Tim Vandiver and medical director/emergency room physician Dr. Michael Fahr stress the importance of getting to a hospital as soon as possible after stroke-like symptoms occur. If the patient meets certain treatment criteria, the medicine must be administered within three and a half hours after onset of symptoms.
Vandiver explained that unfortunately, instead of seeking immediate help, some individuals lay down and take a nap, thinking the symptoms will go away. Instead, they are typically worse, and the window of opportunity to receive the drug has passed.
Fahr explained that there are two types of stroke, and the medicine is only effective in treating one type. He added that there are certain criteria that must be met before the medicine is administered, and there are risks involved. However, the drug can mean the difference in a positive outcome.
According to Manley, Arkansas was only delivering the clot-busting drug t-Pa to less than 1 percent of all stroke patients in the state. “Currently with the AR SAVES program we have increased the delivery to 28 percent of all patients referred, and the percentage continues to increase. This means better medical outcomes for the patients and savings long term for complications surrounding strokes,” he said.
AR SAVES currently covers 41 hospitals in the state with four vascular neurologists. These hospitals include both rural and urban areas. “Just because you are in an urban area doesn’t guarantee you have 24/7 neurology call coverage,” Manley said. “The way we have brought on our hospitals over the past four years has allowed us to decrease the drive time to a stroke center significantly. Currently 78.8 percent of the Arkansas population is within 30 minutes of a stroke center, and 97.9 percent is within 60 minutes. With strokes, every minute counts for better outcomes. We will be bringing on a few more across the state, which will increase the coverage even more.”
Manley said as the number of hospitals covered by the AR SAVES program increases and public awareness is greater, “we can make a huge impact on the delivery of care with our patients here in the state.”
At Conway Regional, the medical staff has administered the clot-busting drug 13 times since the process was streamlined. He said there were 63 other stroke patients where time was a factor, and they were unable to receive the drug. “They potentially could’ve gotten the drug if they had come in,” he said. “Our big push is to get people to realize time is of the essence.”
According to Vandiver, stroke victims appear to be getting younger. He cited a recent case of a man in his 30s who was overweight, smoked and suffered
a stroke. “It’s not just an old person’s (illness),” he said.
Elphingstone only missed three days of work. She is thankful for Conway Regional and the collaboration with UAMS. “I will forever be appreciative.”
While she still experiences numbness in her right hand, Elphingstone knows it could have been much worse. Her advice for anyone experiencing stroke symptoms: “I would advise them to get to the hospital as soon as they can; call an ambulance.”
