1. Statewide System of Care for Stroke in Arkansas 2019 AR SAVES Telestroke Conference September 26, 2019 James Bledsoe, MD,FACS State EMS and Trauma Medical Director

3. Overview Why do this? Is it worth the money?
Where are we and what do we need?
Towards a ‘Time Critical Diagnosis’ system in Arkansas

4. (Approx. 1500 Stroke deaths/year)
Why do this? Arkansas compared to US Average (Age-adjusted death rates per 100,000), 2014
Arkansas
United States
Stroke
rank #7
(Approx Stroke deaths/year)
36.2
Source: Centers for Disease Control and Prevention. CDC Wonder.

5. Is it worth the money? Time is Brain
Every second 32,000 brain cells die
Every minute 2 million brain cells die
For every hour, up to 200 million brain cells die and the brain ages 4 years
Stroke is the leading cause of long term care admission among Arkansas adults younger than 65 years of age!

6. Chain of Survival
A coordinated response system for time critical conditions such as stroke & STEMI has shown to prevent mortality up to 10% *
Components:
Community Education
Emergency Medical Services
Hospitals - Stroke (Comprehensive or Primary Stroke Centers, and Acute Stroke Ready Hospitals)
* Source:

8. Stroke system of care
Community education – 1/3rd recognize signs and symptoms of stroke, and < 50% call 911
Pre-hospital/EMS protocols – Standardized stroke screening scale, early identification, destination & transfer of care protocols
Hospital protocols – Stroke team delivering protocol-driven care
Stroke hospital designation – Joint Commission’s Comprehensive stroke centers , Primary stroke centers, and Acute stroke-ready hospitals

9. Community Education

10. Components of SW Regional Approach
EMS
Pre-hospital stroke screen
Pre-hospital notification
Blood glucose check
Stroke banding
Last known well time documentation
Hand-off form to ED

11. Arkansas Stroke Ready Hospital (ArSRH) Designation
A voluntary hospital designation program implemented by the Arkansas Department of Health approved by the Arkansas Board of Health working with ASCTF and its members.
Standards similar to Joint Commission’s Acute Stroke Ready Hospitals designation
Potential hospitals in Arkansas – 54 AR SAVES hospitals, and 7 Mercy hospitals

12. Arkansas Stroke Ready Hospital (ArSRH) Designation Key components
24/7 ED coverage
Designated stroke coordinator
Availability of standardized acute ischemic stroke protocol
Transfer and Transport protocol in place
24/7 Physician readily available – either a neurologist on-site or
Telestroke coverage
24/7 CT availability
24/7 hospital laboratory staffed
Participate in Arkansas Stroke Registry and submit stroke patient data

13. Receiving Site Capabilities
4 Post Alteplase monitoring capable
Jefferson Regional
Conway Regional
CHI Hot Springs
Wadley Regional

14. Receiving Site Capabilities continued
3 IR and post alteplase monitoring capable
Washington Regional
Baptist Little Rock
Baptist Fort Smith

15. 1Neurosurgery, Neuro Critical Care IR and Neuro Intensivist, ICU Capable
UAMS

16. Regional Approach for Stroke (2017-2018)
SW TRAC

17. Act 203 of the 91st General Assembly amended the 2015
What is in the Future?
Telemedicine
Act 203 of the 91st General Assembly amended the 2015
Telemedicine law which was more restrictive.
This law allowed more access by lessening restrictions at the site of origin so long as a professional relationship existed.
Also addressed insurance coverage.
Pilot program for closed head injury transfers.
Telemedicine is markedly under utilized and could help immensely in accessibility, availability and proper transfers. Aid in transferring some who may not have been sent and avoid unnecessary use of EMS.
This Act allows compensation to the distant site specialist the same as a face to face consultation.

18. Mobile Stroke unit with head CT scanner.

19. CT scanner in a mobile unit

20. Arkansas Time Critical Diagnosis (TCD) system
Trauma
Trauma
Stroke
TCD
(Community,
EMS, &
Hospitals)
STEMI
Questions?!