‘SWAT team’ combats stoke at CMH

State designates hospital as Stroke Care Center
HUDSON–It’s called the “golden window”–the four-and-a-half-hour period between the onset of a stroke and time when the best treatment available is no longer effective, leaving some patients facing permanent disability or even death. The challenge for the medical profession is finding ways to take advantage of that window. Last week Columbia Memorial announced that it has been designated by the state Department of Health as a hospital capable of doing that.

At a press conference Friday, June 7 at the hospital, Anna Colello, the administrator of the state health department’s statewide Primary Stoke Centers designation initiative, said that Columbia Memorial is now one of 119 hospitals in the state that meets the standards required for a stroke care center. The designation, which certifies that the hospital diagnoses and treats stokes within that golden window at all hours, is a voluntary program. Half the hospitals in the state now have the designation. The state will monitor the performance of the hospital annually, she said. Hospital President and CEO Jane Ehrlich put the need for a local stroke care center in perspective Friday, saying that stroke is one of the three leading causes of disability in the nation and the two-county region served by Columbia Memorial could expect to see as many as 300 stroke victims a year. Having a qualified stroke center in this rural region means time could be saved in applying treatment. “Time saved is brain saved,” she said, a point emphasized by the estimate that about a million brain cells a minute die when a clot or bleeding disrupts blood flow to the brain, causing a stroke.

The stroke team at the hospital includes “a designated group of people every hour of every day ready to treat you,” Ms. Ehrlich said. But smaller rural hospitals like Columbia Memorial may not have immediate access to neurologists trained to diagnose stroke and recommend the appropriate treatment. The hospital, which does have two neurologists on staff  who have the credentials for stroke diagnosis, needed access to more physicians with that training to meet the 24/7 coverage standard. That hurdle has been overcome in the case of CMH by a telemedicine system that allows neurologists under contract with the hospital in distant locations to view and diagnose a patient if a staff neurologist isn’t available.

“A lot of pieces had to come together to build this team,” said the hospital’s medical director, Dr. Norm Chapin. He said that the hospital can now have a CT scan of the brain of a potential stroke victim “within 25 minutes of the patient arriving.” In addition to the hospital medical personnel, “EMS teams have been very supportive” of the stroke center effort, he said.
Dr. Chapin said that between 140 and 150 employees in many departments have been trained to respond to a “code neuro” emergency as soon as the hospital learns that a stroke patient is en route.

“It starts with the dispatchers,” he said.

Dr. Jack Keene, director of emergency services at the hospital, characterized the combined approach as “like a SWAT team,” adding that the time from the a patient arriving at the hospital to the time doctors can begin treatment with the  “clot busting” medication called t-PA (tissue plasminogen activator) is less than one hour in those cases where a clot has caused the stroke.

The medication, which was approved for stroke victims in the mid-1990s, is one of several treatments, depending on the circumstances of the case, but it is “the only medication shown to dramatically improve the patient,” Dr. Chapin said.

Dr. Keene cited the case of a 63-year-old man who collapsed at home from a stroke, was rushed to Columbia Memorial, received timely treatment with t-PA and walked out of the hospital three days later “back to normal.”
Assemblyman Pete Lopez, whose district includes parts of Columbia County, attended the press conference and praised the hospital’s “entrepreneurial spirit.” The phrase may fit the stoke center program because, a Ms. Colello of the state health department noted in response to a reporter’s question, there is no “enhanced reimbursement” to the hospital for providing services as a stroke care center.

“This is a real way we go save lives,” said Dr. Keene.

To contact Parry Teasdale email pteasdale@the columbiapaper.com

Look for signs of stroke
HUDSON–The longer it takes for a person having a stoke to get medical help, the more damage the stroke can do. So Columbia Memorial Hospital hands out business cards listing the symptoms that should alert people that they are having a stroke and what to do about it. They form the acronym FAST, and stand for:
•Face, uneven smile, facial droop
•Arm, arm weakness, arm numbness
•Speech, slurred speech, difficulty speaking or understanding
•Time, call 9-1-1 immediately.
The card instructs the reader: Have the ambulance go to the nearest stroke center.
Major stroke risk factors include:
•High blood pressure
•High cholesterol
•Heart disease
•Heavy alcohol use
•Physical inactivity, obesity
•Atrial fibrillation (irregular heartbeat)
•Family history of stroke.
CMH Medical Director Dr. Norm Chapin said the hospital is “trying to educate the community to call 911 just like we did with heart attacks.” He said the hospital’s outreach program is working with doctors, nurses, educators and the health departments in Columbia and Greene counties to get out the word about stroke.
More information is at American Stroke Association, www.strokeassoc.org or 1-888 4-STROKE or National Stroke Association, www.stroke.org or 1-800 Strokes.

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