Stroke: Who Will Save Your Life?
As part of their new Stroke Project, Mediclinic and ER24 have prioritised the roles of four people: paramedics, EC doctors, radiologists and physicians/neurologists. They all play crucial but different roles in managing the effects of a stroke.
Ten South Africans suffer a stroke every hour, according to research by the Heart & Stroke Foundation of South Africa. A new project by Mediclinic and ER24 aims to ensure these patients receive effective, timeous treatment – and avoid lasting brain damage.
“A stroke is a major medical emergency,” says Dr Melanie Stander, Emergency Medicine Manager: Mediclinic SA. “But for many years in SA, there wasn’t an urgent and standardised approach to treat stroke patients.” The Stroke Project aims to correct that.
Today, emergency medical experts are armed with a comprehensive body of recognised international evidence that shows if stroke patients are treated in a standardised and timeous manner, with a dedicated multi-professional stroke team, they can emerge with better outcomes.
“The brain is a complex organ that relies on a constant supply of oxygen, carried in the blood,” explains Dr Daniel Fiandeiro, an Emergency Medicine Specialist at Mediclinic Pietermaritzburg. “A stroke interrupts that blood flow, and cuts off the brain’s oxygen supply. That’s very dangerous.”
There are two kinds of strokes, which typically occur for different reasons: an ischaemic stroke is caused by a clot that blocks a major blood vessel leading to the brain, while a hemorrhagic stroke develops when a blood vessel becomes too damaged to carry a stable stream of blood effectively.
In either event, Dr Fiandeiro explains, time is of the essence. “The longer your brain goes without oxygen, the more brain cells you lose.”
A range of emergency medicine experts at ER24 and Mediclinic Emergency Centres are trained to recognise and receive stroke patients with the utmost urgency – identifying warning signs, conducting tests and prescribing appropriate treatment procedures within no more than a few hours of the onset of the stroke.
Who are these experts, and how can they assist? Dr Stander says it all starts in the ER24 Contact Centre, a hub of emergency response innovation. “ER24’s emergency resource officers are equipped with algorithms to help guide emergency calls down the correct response pathway quickly and efficiently,” she says. “These are priority calls, and our team members are trained to ask the right questions, so the system is triggered by certain words or phrases to activate the correct response.”
On the scene, paramedics verify the signs of a stroke by conducting the F.A.S.T test: examining the patient for signs of facial drooping, arm weakness and speech difficulties. They will treat and stabilise any life threatening emergencies first. As part of their secondary assessment they will take a set of vital signs and also look for clinical signs of other medical conditions that may present as stroke mimics example an abnormal blood sugar level and then kickstart the Stroke Project protocols by pre-notification and rushing the patient to the nearest qualifying hospital. ER24 paramedics will pre-notify the hospital they are heading towards, so that staff in that Emergency Centre may notify the radiology department and the referring physician/neurologist ahead of time.
Medics’ decision-making is guided by what Dr Stander calls the “hub and spoke” concept. “Most hospitals are considered spokes: they can provide emergency initial imaging and ongoing treatment and can refer you on to a hub hospital if needed. Hubs are hospitals that can provide the highest level of stroke care – due to the presence of a specialist who utilises advanced imaging to retrieve blood clots in the brain to improve brain blood flow and limit brain damage.”
Once in the Emergency Centre, stroke patients are examined by the Emergency Centre doctor and rushed into radiology, where they undergo CT scans to gauge the cause and severity of the stroke. “The sooner a neurologist sees those results, the better,” says Dr Fiandeiro. “Unfortunately not all stroke patients require the same treatment, and we can’t take risks until we know all the facts. So we have to move quickly, but we have to be very careful too.”
Dr Stander says stroke treatment in SA has evolved to a point where this standardised approach is saving lives. “The faster we move, the more we can do for the patient – at Mediclinic and ER24 we are committed to doing as much as we can.”