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Stroke – Getting the Right Care at the Right Time in the Right Place is Essential

JeffSTAT helicopterStroke comes on suddenly, frequently without warning. In the blink of an eye, the unexpected happens. 911 is called. An Emergency Medical Service (EMS) team arrives, assesses the severity of your stroke and rushes you to the closest medical center that offers the specialized level of stroke care you need. Getting to the right care at the right time in the right place saves lives and makes a difference in whether or not, or how quickly you’ll recover.

Pennsylvania’s Stroke System of Care Act went into effect on June 13. The law ensures that EMS providers follow specific protocols to assess stroke and immediately transport patients to the appropriate hospital for the right treatment in the shortest amount of time. That’s good news for residents of the Delaware Valley, who have access to expert stroke teams standing ready at all times to provide advanced stroke care. Abington Hospital and Jefferson University Hospital are among the few comprehensive stroke centers in the area, and deliver the highest level of care for stroke patients. Abington – Lansdale Hospital is a designated primary stroke center, providing an advanced level of care with seamless transfers to Abington if needed.

“The Joint Commission has determined the requirements for three different levels of stroke care provided at designated Pennsylvania hospitals,” explained Dan Gzesh, MD, director of Abington – Jefferson Health’s Diamond Stroke Center. “Pennsylvania recognizes comprehensive stroke centers, primary stroke centers and acute stroke-ready hospitals,” he said. “Each provides different levels of stroke care. Now, with Pennsylvania’s Stroke System of Care Act, we have a standardized system to ensure stroke patients are assessed immediately and then go directly to the center that offers the level of care needed.”

Evaluating Patients at the Scene

Emergency Medical Services personnel use a simple, rapid means of determining the severity of stroke known as the RACE (Rapid Arterial Occlusion Evaluation) Scale. “It is designed to evaluate patients with acute stroke before they arrive at a hospital,” said Brad Nash, battalion chief, Second Alarmers Rescue Squad (SARS) in Montgomery County. The RACE scale evaluates:

  • facial paralysis (if one side of face droops)
  • arm motor function (if both arms cannot be lifted)
  • leg motor function (if both legs cannot be lifted)
  • head and gaze deviation (inability to hold a position and meet a gaze)
  • aphasia (inability to understand and speak)
  • agnosia (inability to recognize people, objects, sounds)

These measurements, when added together, can determine the severity of a stroke. When a score is higher, the probability of a large vessel blockage is suspected. These patients are candidates for treatment with catheter-based techniques in a comprehensive stroke center like Abington’s Diamond Stroke Center. Nash believes this is a great benefit for the stroke patients SARS transports. “The faster a person with a stroke is treated, the greater the chance for recovery or minimal damage,” said Nash.

From Paralyzed to Symptom Free within Minutes

Catherine Wetherell, 52, attested to what she calls a “miraculous” series of events, after the sudden onset of stroke symptoms in April 2017. Catherine had left work that day, feeling fine, but hit a curb as she pulled out of the parking lot. A concerned co-worker followed her in his vehicle for a few blocks, when all a sudden, Catherine drove into a pole on the side of the road. Catherine was conscious, but confused; slurring her words and paralyzed completely on the left side of her body.

Catherine’s co-worker called the police, who alerted EMS and Catherine was rushed to Abington Hospital – Jefferson Health. The stroke team, led by Hana Choe, MD, assistant director, Neurointerventional Care, performed a rapid assessment. After a series of tests confirmed Catherine’s diagnosis, Dr. Choe performed a catheter-based procedure to remove the clot from a vessel in the right side of Catherine’s brain.

“Because there was a specific system in place and everybody knew exactly what to do—from the EMS team to the hospital’s ER and stroke teams—my symptoms disappeared within minutes of treatment,” said the Wayne resident. Catherine has recovered completely and has experienced no deficits as a result of her stroke.

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