1. Remote Treatment Stroke Center Designation Why and How McCord Smith, M.D. May 14, 2015

2. Michael Frankel, MD

3. Problem We are not providing the best stroke care to the residents of GA. IV tPA 1996: 30% improved outcomes USA 2014: 5% stroke pts receive tPA; ~1/3 of 800,000 could benefit

5. ISC 2014

6. Causes of Underuse Patients arrive at ED too late Patients live too far from PSC Too few Neurologists

7. Why PSC Time imperative Exclusions Stroke Mimics TJC designation 2004

8. Solution PSC2004 CSC2012 RTSC2013 Telestroke2002

11. Georgia: a Special Case Large area Rural Stroke Belt (Buckle) Coverdell 2001 REACH2002

13. STM Experience 2000 Idea 2004 PSC 2009 Reorganize 2013 Good Sam: RTSC 2014 Int Stroke Conf

14. ST. Mary’s Experience # pts receiving t-PA% t-PA 2002-2008252.7% Avg/year3.6 2009-201416312.4% Avg/year27.2

15. FDA Data 1995 mRS 0-1 2-3 4-5 6

16. St. Mary’s Outcomes 2009-2014 (163 patients)

17. Yes We Can 2004: 20 PSC 2014: 1200 PSC Target Stroke 2010 2013: >50% tPA patients given with DTN < 60 min

18. How Commitment Organization Collaboration Education Help

19. Prevention Education Community involvement

20. Home EMS RTSC ER TeleStroke 911 PSC Acute Ischemic Stroke: The BIG Picture CSC SX tPA non tPA

21. We are not providing the best stroke care to the residents of GA. We are not in Kansas anymore