Rapid Response Proves Vital in Stroke Cases

Cornwall, December 17, 2013 – On the last Sunday of July, a 55 year old woman recognized she was having numbness on her right side so decided to call for medical attention. Little did she know her quick decision would have such a drastic impact on her life, as she was unaware she was suffering from the initial stages of a stroke. When the ambulance arrived paramedics promptly diagnosed her onset symptoms and immediately took her to Cornwall Community Hospital (CCH) for further examination. Within minutes the patient was given the clot busting medication “tissue plasminogen activator” (tPA).
This individual did the right thing in calling for assistance, and when the call came in all hands were on deck to provide the patient with the care she so desperately needed. The emergency department (ED) staff communicated with the computed tomography (CT) technician to order a scan, who relayed their findings back to the ED doctor, who discussed the results with a neurologist via Telestroke, who then gave the MD the recommendation to give the tPA. Treatment continues after the drug has been administered with further diagnostic investigations, referral to the interprofessional team for assessment and treatment by the physiotherapist, occupational therapist, speech language pathologist, dietitians, nurses and a social worker to ensure optimal stroke best practice care.

The advancements in stroke care have been well documented recently with this incident further demonstrating the need for continuous investigation into this leading disease. According to a 2011 study by the Canadian Stroke Network, the median door-to-needle time (arrival to administration) for tPA was 72 minutes. The team at CCH, with the help of Telestroke, was able to deliver tPA at a time of 38 minutes door-to-needle, or almost half the average national standard. “When it comes to strokes, time is brain,” said Coordinator of Clinical Pathways, Stroke and Wound Care, Rosa Awad-Maglieri, yet many do not consider stroke a medical emergency. “Physicians can only administer the drug within a few crucial hours after symptoms begin, so knowing the warning signs and treating it as an emergency situation is the only way to salvage brain tissue,” added Awad-Maglieri. Two thirds of the people who have an ischemic stroke do not arrive in time at an appropriately prepared hospital to receive optimal care. The window to administer tPA, the clot busting drug, is four and a half hours from when you first start noticing signs a stroke could be imminent.

Cornwall Community Hospital is a recognized Telestroke site authorized by the Ontario Stroke Network and has been concentrating on promoting early recognition and the rapid response for situations like the one that happened this summer. “Congratulations on the excellent door-to-needle time on July 28. 38 minutes from door-to-needle and 83 minutes from symptoms onset to needle is very impressive,” said Mr. Jim Lumsden, Director of the Champlain Regional Stroke Network.
“It’s our goal to provide high quality care in a timely manner, and this incident proves that our system for delivering that care works. This wouldn’t be possible without the ongoing cooperation from every department in the hospital,” said Janice McCormick, Director, Critical Care, Pharmacy, and Chronic Disease Management. McCormick went on to explain that while the drug administered was successful in this instance it should not be depended on. “The best medication is still prevention. Abstaining from alcohol and cigarettes, while at the same time exercising regularly and maintaining a healthy diet free of high sodium foods, will drastically reduce your chances of becoming a victim of a stroke.”

During the week of November 18 CCH continued with its commitment to excellence and quality care by hosting Stroke Champion Education days to discuss, among other things, the anatomy and physiology of a stroke and best practice to optimize stroke care. Teaming with local therapists from CCH, Stroke Nurse Specialists from the Ottawa Hospital presented topics over a three day span to educate 56 staff members on the best practices in stroke management.

For more information on the warning signs of stroke please visit CCH’s website at cornwallhospital.ca.