The Stroke Chain of Survival
Welcome to the future of stroke care in SA. Mediclinic and ER24 have recently implemented new interventions and treatment measures designed to help stroke patients receive the best, most efficient care. Here’s how ER24 and Mediclinic can help you survive a stroke.
If you suffer a stroke, every minute counts. The earlier you receive expert treatment, the better chance you have of avoiding lasting damage to your brain and critical functions. To ensure you receive the right treatment, at the right time, Mediclinic and ER24 have committed to a formal Stroke Project that standardises stroke protocols – on the scene, in the ambulance and in the hospital.
“For many years doctors believed there was not much that could be done for stroke patients,” says Dr Melanie Stander, Emergency Medicine Manager: Mediclinic SA. “But that has changed. There is a new body of international evidence that shows patients can have much better outcomes, to the point where they are in a better position toregain full physical function – provided they are treated in a standardised and timeous manner, with a dedicated multi-professional stroke team.”
Mediclinic has implemented a standardised protocol at all its facilities in South Africa designed to ensure all patients are received as potential stroke cases, and treated as carefully and quickly as possible.
“There are different kinds of stroke,” explains Dr Jaclyn Prim, Emergency Centre Head: Mediclinic Vergelegen, “but they have one thing in common: they can do immediate damage and have long-lasting effects. Whether it occurs due to a clot or a bleed in a blood vessel, a stroke leads to an interruption in the blood supply to your brain – and this deprives your brain tissue of vital oxygen and nutrients.”
A recent study shows that the sooner a patient is assessed after the onset of a stroke, the earlier medical experts may be able to intervene and prevent further damage to the brain, says Dr Stander. “The aim of the Stroke Project is to get each stroke patient into the treatment system as quickly as possible – and to make sure the paramedics, doctors and other experts they see, know to treat their case as a genuine medical emergency.”
The stroke chain of survival starts in the prehospital space: emergency resource officers at the ER24 Contact Centre use sophisticated algorithms to recognise verbal signs of a stroke – even if the caller does not know a stroke is taking place. ER24 uses the internationally accepted Cincinatti Stroke scale checklist to evaluate whether the patient may have had a stroke (the FAST algorithm) even before the emergency services arrive on scene.
Those extra few minutes could be the difference between life and death. And notifying the receiving hospital to ensure they can expedite their stroke team and subsequent stroke pathway is an important link to the care pathway.
“The challenge with stroke is that although there are different kinds, which respond to different treatments, they present the same,” says Dr Prim. “Up to 80% of strokes are ischaemic in origin, meaning a clot has caused a blockage – in many of these cases, we can use a technique known as thrombolysis to break up the clot and restore normal blood flow.”
The danger, Dr Prim says, is that for many other stroke patients, this treatment could be fatal, as it can cause bleeding – and it can be impossible to tell the difference between them on sight alone.
For friends and family, first aid begins with an immediate call to 084124 for assistance. If your patient is unconscious, it’s preferable you try to put them into the recovery position. Do not try to give your patient anything to drink or eat, as their swallowing may have been affected. From a pre-hospital care perspective, it’s critical we identify any lifesaving interventions that may need to be started, and also look for any stroke mimics for example hypoglycaemia. “The only way we can decide on an appropriate, safe method of treatment is through a series of tests, and brain imaging scans, done in the Emergency Centre.”
Patients need to be tested, and treated accordingly, within a few hours of the onset of a stroke, for optimal outcomes. “ER24 plays a vital role in getting these patients the treatment they need – the earlier you call 084 124, and the sooner you are brought into the stroke system of care, the better your chances of recovery.”