May is National Stroke Awareness month, a nationally recognized partnership between the National Stroke Association, the American Heart Association, and a myriad of nonprofits to educate the public about the prevention of stroke and to support stroke survivors.
The National Stroke Association calls a stroke a “brain attack” occurring when blood flow to an area of the blain is cut off. Strokes can be ischemic (a clot) or hemorrhagic (bleeding). The brain cells are then deprived of oxygen and begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain are lost. This includes muscle control and memory. Strokes kill more than 133,000 Americans each year. But 80 percent of strokes are treatable if symptoms are caught in time. Here in the River Valley, the AR SAVES Program works to do just that.
AR SAVES (Stroke Assistance Through Virtual Emergency Support) is a statewide telestroke program via the University of Arkansas for Medical Sciences Center for Distance Health. A telestroke program is a sub-category of telemedicine, a service often employed for medical consultations in rural areas. Through the use of a high-speed internet connection and at the minimum a laptop with video capabilities, telemedicine allows a medical specialists to provide remote treatment for patients.
AR SAVES began in November 2008 and now includes 54 hospitals, nearly two-thirds of the hospitals in Arkansas. Saint Mary’s became a part of the partnership in 2010. The program offers participating emergency rooms with 24-hour live two-ways calls with a vascular neurologists. Each of these partnering sites is staffed with people trained in recognition, assessment, and treatment of strokes. Each site is also equipped with telemedicine technology, ongoing training for personnel, support for dedicated telestroke coordinator (nurse facilitator), and ongoing continuing education.
Participating hospitals also treat patients with life-saving drug alteplase (trade name Activase). According to the National Stroke Association, “currently more than 30 percent of eligible patients receive tPA (alteplase), whereas before, only one percent would arrive in time for any intervention.” Before the proliferation of the AR SAVES program, Arkansas was ranked number one in the nation for stroke deaths. Thanks to this innovative network, Arkansas now ranks sixth and dropping with each passing year.
This past year the AR SAVES program was one of only eight recipients in the nation to receive the national RAISE (Raise Awareness in Stroke Excellence) Award, a designation presented to individuals and groups who excel in raising stroke awareness, prevention and recovery. But how does the program work?
Tim Tanner, ER nurse and facilitator of the AR SAVES program at Saint Mary’s Regional Medical Center, explains that the telestroke conference is basically a live video chat with a stroke neurologist. After the regional ER has admitted the patient, and the blood work and a CT scan is ordered, ER staff go online with the an onsite neurologist at UAMS. An information technology (IT) person joins the call to address any technical problems that might arise.” Basically we are the hands for the doctor,” Tim explains. The neurologist will work with the ER to do an 11 point exam on the patient and, if needed, will prescribe Activase, which acts as clot buster for the stroke. Tim calls it “Draino for the brain or braino. In most cases this drug reduces the odds of death. Sometimes the patient is then transported to UAMS for further testing or treatment.
The national goal for “door to needle time”— time the patient walks in the door, tests done, and drug prescribed — is 60 minutes or less. In most cases Saint Mary’s meets or exceeds that national goal. Other River Valley hospitals in the AR SAVES program are excelling as well. Johnson Regional Medical Center received the Door to Needle Award from the AR SAVES program at the eighth annual conference in 2017. The award represents the program’s highest honor for achieving the fastest stroke treatment process of the 51 participating hospitals in 2016. JRMC emergency stroke patients received diagnosis and treatment faster than any other AR SAVES site with a remarkable door-to-needle time of 38 minutes.
“I’ve been in ER work for 20 years,” explains Tim. “But working with this program over the past two years, I feel energized. I learn something new every day.” Tim stresses the ongoing team effort of the AR SAVES program, complimenting his ER team and their dedicated work. He says that before this program, stroke patients in smaller cities didn’t have much hope. “Unless you were in a city like Little Rock or Fort Smith, there wasn’t really anything ER staff could do for stroke patients, just a pill and a prayer,” as he called it.
While access to UAMS neurologists and life-saving drugs are certainly a key part of the program, AR SAVES is about much more than the telestroke conference events. It’s also educating the public about prevention and how to catch warning signs early. And it’s about supporting stroke survivors. To this end, AR SAVES offers public outreach events and resources around the state to schools and organizations. It is this diligent outreach that has removed Arkansas from number one ranking stroke state in the nation.
To fully understand the transformation, in 2017 the state-wide AR SAVES program conducted 826 consults with ER patients; 274 people were prescribed Activase, and 1,510 community education events were held reaching around 264,000 Arkansans. Regionally, Saint Mary’s program provided 56 consults, administered the medication 23 times and held 56 events reaching close to 13,000 people. Educating the public is Tanner’s passion. “I’ll talk to a room of five people or a room of 5,000,” Tim says. It’s important to note that Dardanelle Hospital is also now a member of the AR SAVES network and is working locally to add to this success.
Tim reminds the public that after a stroke every moment is critical. “A patient is losing up to 32,000 neurons a second,” he stresses. This equates to a person aging up to three years an hour. Awareness of symptoms and access to timely treatment is what makes survival possible. Tim and the AR SAVES partnership around the state teach the BE FAST method for early stroke diagnosis and action.
BALANCE: Is there a loss of balance?
EYES: Is there a vision change in one or both eyes?
FACE: Is there facial weakness, drooping or uneven smile?
ARM: Is there arm numbness or arm weakness?
SPEECH: Is there slurred speech, difficulty speaking or understanding?
TIME: Call 911 and get to the hospital immediately.
Tim stresses the importance of trying to ascertain and document the last known well-time, as this information will help health professionals during treatment.
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Whenever speaking with the community, Tim brings what he calls the “mega brain,” an oversized inflatable brain model that serves as a teaching tool. It’s large enough to walk through and is a hit with audiences both young and old. He has also created a game for kids that teaches about the stroke and mechanical thrombectomy process (clot removing surgery). “It’s an Operation game,” he explains, “where all the parts have been replaced with veins and arteries.” A skittle represents the clot and the game illustrates how proper medication can push the clot out and let the blood flow again.
Tim says it’s easy to do these talks and spread the word about prevention and treatment because “once you have seen the model you’re sold on it.” He notes that we often think of stroke victims as older people, but there are stroke survivors as young as 27 years old. Though rare, strokes can even happen in utero.
Tom Berryhill, a local stroke survivor thanks to the AR SAVES program and rapid response of the Saint Mary’s ER team, recently took part in a Lunch and Learn at UAMS along with Tim. The featured speaker was one of the doctors who operated on Tom via the AR SAVES program and the two were able to meet again. Tim calls this one of his “proudest moments.”
Between community engagement and state of the art treatment facilities, AR SAVES hopes to continue to decrease stroke deaths in Arkansas. Since the program’s creation in 2008, 99 percent of Arkansans are now within a 60-minute drive to an AR SAVES participating hospital. These numbers are rare for a largely rural state.
You can test your own stroke knowledge and hear voices from around the state via the AR SAVES webpage where you can find a series of survivor stories from several participating hospitals, resources for nurse facilitators and EMS staff, and annual reports from previous years. Tom Berryhill was featured in the 2017 final report. They also highlight ongoing events, many taking place during the month of May. You can visit AR SAVES online at arsaves.uams.edu to learn more about the statewide program or contact the ER department at Saint Mary’s to book a free visit with Tim.
Tim will share his knowledge of effective community outreach programs when he serves on a panel at the National Stroke Association meeting in May. He’ll be a featured contributor to the panel entitled, “Community Outreach Done Right.” Tim notes that he will gladly speak to any civic, community and church groups throughout the region at any time of the year.
AR SAVES in the River Valley: stroke awareness and new technology saves lives
Story by Meredith Martin-Moats