From the moment you start to experience stroke symptoms, the clock starts ticking. Every minute that passes can make a difference in how many of your brain cells are dying – approximately 2 million per minute of delay as it turns out.
Saving brain cells translates to whether and how quickly you can recover function in your arms, legs, speech and ability to think. Approximately 87 percent of all strokes are ischemic strokes. Ischemic strokes occur when a blood vessel carrying blood to the brain is blocked by a blood clot. Having an ischemic stroke makes you a candidate for a clot dissolving treatment – called tPA – which is effective if you are treated within 4.5 hours of symptom onset. If you are like most people, you might ignore your symptoms or brush them off as something minor instead of seeking treatment immediately.
Perhaps you are one of the ones who've paid attention to the ad campaigns and actually call 911 at the onset of your stroke symptoms. However, where you live might still determine your outcome.
Approximately 61 million people (20 percent of the U.S. population) live and work in rural areas. EMS response, treatment and transport during a stroke is not the same in rural America as it is in urban America.
Volunteer first responders are scattered across a large geographic and sparsely populated area and may or may not have had recent training or experience with stroke care. In fact, the ambulance may not show up at your door for 30 minutes to an hour after placing that 911 call and it could be another 30 minutes to an hour to get you to the nearest hospital.
Upon arriving at the rural community hospital emergency department, you will need to get registered as a patient to allow the emergency room physician to order a head CT scan – a necessary diagnostic tool for making sure you do not have a bleeding (hemorrhagic) type stroke. If you were one of the 10 percent of stroke victims having a bleeding stroke instead of an ischemic stroke, administration of tPA could increase your bleeding or even result in death. The CT scan is frequently read directly by a stroke neurologist, a specialist that is not commonly available at small community hospitals. Meanwhile, the clock ticks as decisions are made to airlift you and a copy of your CT scan to a larger hospital with a stroke neurologist. While all of this is happening, you have just missed the 4.5 hour golden window of opportunity to receive tPA.
Earlier this year, a second type of treatment for selected people with acute ischemic stroke was discovered and is currently available as “standard of care” treatment for acute stroke. The treatment, known as a thrombectomy procedure, allows highly trained doctors to remove the clot within the brain, using special devices threaded up into brain vessels, similar to a cardiac catheterization. This treatment can be used in some, but not all, patients up to 24 hours following initial stroke symptoms. Quickly identifying which patients qualify for this treatment is critical, as well as transporting the patient to a hospital with specialized, comprehensive stroke care, where thrombectomy procedures can be performed.
Closing the Gap
The value of connected health and effective telehealth is never solely about the enabling technology, but also about the people and processes surrounding the technology. Such is the case with improving time to care for stroke for those living in rural America.
The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
Originally published February 23, 2018