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Acute stroke response is again close at hand in Westerly area – The Westerly Sun

Posted: January 19, 2020 at 3:45 pm

WESTERLY "Time is brain" is a phrase used by doctors to stress the importance of rapid care for stroke patients.

"If someone waits too long, unfortunately, there may be less that we can do to help them," Dr. Ryan Carter, who chairs the Westerly Hospital Emergency Department, said during a recent interview.

With the importance of a speedy response in mind, Westerly Hospital, after completing a long certification process, is once again able to accept and provide initial treatment to all but the most severe stroke patients. The service went into effect on Jan. 1.

For about the previous 10 years, Rhode Island Department of Health regulations required stroke patients to be treated at either primary or comprehensive stroke centers. But now a third category acute stroke ready has been established. Westerly Hospital gained the certification as an acute stroke ready facility from the Joint Commission on Accreditation of Healthcare Organizations last February, and the state's emergency medical services protocols were updated more recently to reflect the new certification category.

The certification allows smaller and rural hospitals to demonstrate their ability to comply with standards of care for the initial treatment of stroke patients when prompt action and proper medications can save lives and limit the long-term disabling effects of strokes.

As an acute stroke ready facility, Westerly Hospital has shown it has the infrastructure and capability to care for acute strokes, including administration of intravenous thrombolytic therapy. Most acute stroke patients will be transferred to a primary or comprehensive stroke center that would provide ongoing care and / or endovascular procedures after initial stabilization in Westerly.

To gain the acute stroke ready certification, the hospital had to demonstrate four basic capabilities: access to trained medical personnel who are able to assess stroke patients; access to a neurologist; quick access to a CAT scan; and a system in place to deliver the clot busting intravenous thrombolytic therapy.

"Because time is brain we need to get this medication to these patients as quick as possible," said Lisa Bedard, stroke and neurodiagnostics manager at Westerly Hospital.

The lack of in-house neurologists had previously been an obstacle for Westerly Hospital, but the evolution of telemedicine and the hospital's acquisition by Yale New Haven Health in 2016 allow Yale New Haven neurologists who specialize in stroke care to assess patients remotely through the use of a telecart. The device includes an audio component and a high definition camera that enable neurologists in New Haven to see and hear patients as if they were in the same room. "The doctor can see anything that I can see," said Marlea Bergeson, a registered nurse and clinical coordinator of the Westerly Hospital Emergency Department.

When assessing whether a patient has suffered a stroke, doctors look for both overt and subtle signs such as facial droop, facial asymmetry, whether a patient's pupils are equal, and quality of speech. Neurologists in New Haven are notified as soon as Westerly Hospital receives a potential stroke patient and can see CAT scan results immediately in real time before patients even leave the scan room.

In addition to being certified as an acute stroke ready facility, the hospital worked with the Rhode Island Department of Health's Ambulance Advisory Board to get protocols changed to allow for the acceptance and treatment of stroke patients.

"That was a big hurdle to get over because we had to convince them so everyone knows what acute stroke ready hospitals are," said Tim Law, chief paramedic for Westerly and L+M hospitals and a member of the Rhode Island Stroke Task Force.

With the new protocols in place, patients who suffer strokes in the Westerly region now stand a greater chance of receiving care quickly. Rather than a 20 minute ride to New London or a slightly longer trip to Wakefield, they can be treated at Westerly Hospital.

"The advantage to that is time. Somebody in Westerly will get here and get imaged and treated more quickly than being transported to L+M or South County Hospital and that is advantageous from a health point of view," said Dr. William Conlin, an emergency medicine physician at Westerly Hospital.

Because each passing minute is critical, when paramedics respond to a 911 call they score a patient's symptoms to determine the type of facility a patient should go to. More severe symptoms require treatment at a primary or comprehensive stroke center.

Ralph Miro, director of nursing for the Westerly Hospital Emergency Department, stressed the importance of public awareness of stroke symptoms. He recommended using acronym FAST: face drooping, arm weakness, speech difficulty, and time to call 911.

"The tendency for many families is to put the patient in the car and bring them in that manner, but actually what they should do is access 911 and ensure that they have highly trained medical personnel to bring them in as soon as possible," Miro said.

Strokes occur when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts.When that happens, part of the brain cannot get the blood and oxygen it needs.

Bedard thanked state Sen. Dennis Algiere, R-Westerly, for his help in developing new legislation that allows for the recognition of acute stroke ready hospitals in Rhode Island.

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Acute stroke response is again close at hand in Westerly area - The Westerly Sun

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