For stroke care, trauma of­fers per­fect model

The Columbus Dispatch - - Front Page - Mark Bain, M. D., is a neu­ro­sur­geon at the Cleve­land Clinic in Cleve­land, and a board mem­ber of the So­ci­ety of Neu­roIn­ter­ven­tional Surgery, based in Fair­fax, Vir­ginia.

Ohio, don’t have a pro­to­col for routing stroke pa­tients to care cen­ters, which means they of­ten take these pa­tients to the near­est med­i­cal fa­cil­ity. This could be a life-or-death de­ci­sion for the pa­tient be­cause mil­lions of brain cells die each minute blood flow is de­nied to the brain.

Ari­zona, Ten­nessee, Colorado, Mas­sachusetts and Vir­ginia are chang­ing the way they think about triage and trans­port so that se­vere stroke pa­tients get to the right place at the first time. Our state has an op­por­tu­nity to join these lead­ers on the cut­ting edge of stroke care, giv­ing the peo­ple of Ohio the best chance for not only sur­vival but also a full re­cov­ery.

Stroke ad­vo­cates and ex­perts are work­ing right now with leg­is­la­tors in Colum­bus to change hos­pi­tal des­ig­na­tions and EMS pro­to­cols to fa­cil­i­tate trans­port of these pa­tients di­rectly to a Level 1 or com­pre­hen­sive stroke cen­ter. House Bill 464 calls for the recog­ni­tion of stroke cen­ters based on their abil­ity to treat se­vere stroke and the es­tab­lish­ment of pro­to­cols for treat­ing stroke pa­tients. But this only gives us half of the so­lu­tion. First re­spon­ders need clear guide­lines for trans­port­ing se­vere stroke pa­tients in or­der to en­sure that ev­ery pa­tient has ac­cess to the life-sav­ing treat­ment they need right away.

Decades ago, when states and lo­cal­i­ties adopted a Level 1 trauma cen­ter model, it was with the un­der­stand­ing that teams that are trained to treat trau­mas and see hun­dreds of cases a year are most likely to pro­duce life-sav­ing re­sults for pa­tients. To­day, EMTs take se­vere trauma pa­tients di­rectly to those fa­cil­i­ties.

The stan­dards should be no dif­fer­ent for the nearly 800,000 peo­ple per year who ex­pe­ri­ence a stroke in the U. S.

Pa­tients de­serve a fully in­te­grated care team — one that in­cludes providers who are highly ex­pe­ri­enced in stroke care and who do this work of­ten. Level 1 stroke cen­ters are staffed for ev­ery stroke even­tu­al­ity, which is im­por­tant be­cause treat­ing stroke re­quires com­plex de­ci­sion-mak­ing. The abil­ity to ef­fi­ciently de­liver the mul­ti­fac­eted care that se­vere stroke pa­tients need is only guar­an­teed at Level 1 cen­ters and re­quires a mod­ern ap­proach to up­dat­ing EMS pro­to­cols.

Se­vere stroke pa­tients who re­ceive the proper care leave the hos­pi­tal days sooner and are twice as likely to be in­de­pen­dent within 90 days. This di­min­ishes the need for ex­ten­sive re­ha­bil­i­ta­tion, which re­duces long-term care costs.

While we work to im­prove the trans­port pro­to­cols for pa­tients, tools are emerg­ing that will make it eas­ier for EMTs to make bet­ter de­ci­sions in the field. The So­ci­ety of Neu­roIn­ter­ven­tional Surgery re­cently de­vel­oped a mo­bile app de­signed for first re­spon­ders that takes the guess­work out of triage. The app pro­vides first re­spon­ders with stroke scales so they can eval­u­ate a pa­tient’s symp­toms and make an in­formed de­ci­sion about the sever­ity of a stroke and, as a re­sult, the care cen­ter best equipped to treat that pa­tient.

Ul­ti­mately, it all comes down to time. Ev­ery minute of de­lay be­fore a pa­tient re­ceives stroke care means an ex­tra week of re­cov­ery. And given that we know the trauma model works, we have to ask our­selves: Do stroke pa­tients de­serve less?

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