Arkansas leads nation in stroke mortality

— Phillip Davidson was on a break between the business education classes he taught at the Arkansas Juvenile Assessment Treatment Center in Alexander when he first realized he was feeling strange.

“I just didn’t feel right,” he said. He went to the clinic at the center, where a nurse discovered that his blood pressure was elevated. Waving off an offer to call for help, Davidson began struggling to stand. The nurse called an ambulance, this time without asking.

Shortly after the call was made, Davidson lost control of the right side of his body.

“I didn’t have a clue it was something as serious as a stroke,” he said.

From that moment, the clock was ticking for Davidson. Dr. Scott Archer, director of Saline Memorial Hospital’s emergency department, said medical personnel had about four hours to confirm that Davidson had experienced a stroke, make the right diagnosis about the type and severity of the stroke and, if recommended, administer a drug that could restore normal blood flow to Davidson’s brain.

“It has been demonstrated that if we can initiate treatment for certain types of stroke within 4 1/2 hours of symptom onset, the patient has a chance for full recovery,” Archer said.

Arkansas leads the nation in stroke mortality with 58.8 deaths per 100,000 Arkansans, according to the National Center for Disease Control and Prevention. In 2006, the last year with available data, there were 1,884 stroke-related deaths in Arkansas.

Trying to reduce that number, hospitals in the state, including Saline Memorial, have partnered with stroke specialists at UAMS in Little Rock and the Sparks Health System in Fort Smith to form Arkansas the SAVES, (Stoke Assistance Through Virtual Emergency Support) program.

Using the latest in communications technology, nurses and doctors in emergency rooms across the state can consult with neurologists and neurosurgeons around the clock.

When Davidson arrived at the Saline Memorial Hospital emergency room in Benton following his stroke, he was attended by Chuck Mason, a staff ER doctor.

“A stroke can have very broad symptoms, from slurred speech to dizziness to being unable to move their arms and legs,” Mason said. “Once you recognize that it is a stroke, the type of stroke can be determined by lab work. A CT scan of the head will show a thrombolytic stroke caused by a blood clot blocking blood flow in an artery of the brain. We can go after it with drugs.”

Once a stroke is diagnosed, a nurse at the hospital contacts the SAVES call center, said Terry McCormack, a registered nurse and the ER nurse manager.

Using a two-way television link, the nurse and doctor will talk with a SAVES outreach nurse like Loretta Williams, who said, via a sample hook-up, that a stroke specialist can be called and connected with the medical team in the ER within a few minutes.

“We do four mock patient calls a month to make sure all the nurses are up to speed and can move quickly,” she said.

Using a dedicated cell phone, the call-center nurses contact a stroke specialist like Dr. Salah Keyrouz, medical director of Arkansas SAVES and director of the neurology and neurosurgery and stroke programs at UAMS.

“There is a time window for the patient,” Keyrouz said. “There are only three or four specialists across the state with the expertise needed, and transporting a patient to one of them loses that window.”

Keyrouz said that medical experience shows the odds of recovering from a stroke double when the one drug approved for use on stroke patients is administered intravenously within the allotted time. The drug is a tissue Plasminogen Activator, or t-PA.

Before the drug is given, the specialist will talk not only with the nurse and doctor on the scene, but with the patient and family members or others who might have been with the patient when the symptoms were first noticed. That will help determine if the drug is appropriate for the patient, Keyrouz said.

“The drug is not without risk,” said Mason, who described t-PA as an extreme blood thinner. “It can cause bleeding in the brain where there was not any before, and that will cause a major catastrophe.”

Mason said the decision on whether to give the drug is complicated.

“We have to weigh the options and see if the risks are justifiable,” he said. “SAVES gives us someone who is a specialist to help us make a decision. The doctor at UAMS helps us point out the possible outcomes to the patient.”

Once the drug is given to a patient, Keyrouz said, time is no longer critical and the patient can then be taken to another facility or remain in the care of the attending hospital.

He said SAVES receives an average of one call a day, but that he has had two calls in the last 15 hours.

McCormack said she has heard plans are under way to extend the two-way television link for trauma causes. It has already been used for pediatric emergencies with Arkansas Children’s Hospital, and Keyrouz said the link has been used for problem pregnancies.

The medical team at Saline Memorial Hospital and at UAMS helped Davidson make it through his stroke. He received the t-PA drug within three hours after the symptoms first occurred.

“This was definitely an eye-opener for me,” he said. “I’m thankful for this new technology and the care I received at Saline Memorial.”

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