Published on July 08, 2011

Stroke Alert Drill Provides Learning Experience

The QC’s first Certified Primary Stroke Center

Two co-workers go outside for a break. In mid-conversation, Katie involuntarily drops what she is holding in her left hand. Ann watches in shock as the left side of her friend’s face visibly begins to droop.

Equally disconcerting: Katie is having trouble speaking and slurs her words.

Ann asks herself, “Could Katie be having a stroke?”

Knowing there’s no time to waste, she calls 911. The dispatcher’s questions are rapid-fire: “Is the patient alert? Is she breathing normally? Is she able to talk? What time did the symptoms begin?”

The scenario is only a drill, but Genesis and MEDIC EMS professionals will respond as if it is real.

The time is 9:50 a.m. June 3, 2011, and Katie, the “patient” has a head-start of sorts. If she is having the most common type of stroke, she has only 4.5 hours at the onset of symptoms to receive an intravenous drug that will dissolve strokecausing blood clots and help prevent brain damage.

Unlike many in similar circumstances, Katie is fortunate to be with a friend who knows the exact time her symptoms began. That knowledge will be crucial once she reaches the Genesis Medical Center, West Central Park campus in Davenport. The hospital was the first in the Quad Cities area to earn national distinction as a Joint Commission Certified Primary Stroke Center.

Stroke Alert

A MEDIC EMS ambulance arrives. Paramedics pretend to give Katie an I.V. of normal saline; check her vitals and blood sugar; and, assess her neurological status. With an ambulance en route and communication to the Emergency Department, a mock “Stroke Alert” is called.

“ETA three minutes,” the paramedic notifies the hospital.

“Stroke Alert” is announced on the hospital intercom, and Genesis health care professionals begin preparing for the patient before she even arrives.

For the most rapid response, Genesis has instituted a “Stroke Alert” at all its hospitals to mobilize a broad spectrum of departments to be ready when a stroke patient arrives. The stroke alert activates areas like Emergency Services, Nursing, Lab, Neurology, Radiology, Pharmacy and Spiritual Care to respond in a well-planned, coordinated system of care.

As is the case in this scenario, paramedics often initiate stroke alerts in the field.

“When the patient arrives at the hospital, the clock begins,” says Angie Overton, RN, MSN, CNRN, Genesis stroke center coordinator. “If clot-busting drugs are to be given, it’s our goal to have them be administered within 60 minutes of arrival to the hospital... even sooner if possible.”

“Time is brain” when it comes to stroke, she says. For every minute that ticks by, more than 1.9 million neurons die.

Throughout the June 3 drill, MEDIC EMS and hospital staff are reminded the mock stroke alert isn’t real so that care is not diverted away from real Genesis patients who need immediate care.

At the hospital

Multiple efforts begin once Katie arrives, and the Emergency Department room fills with experts trained to handle stroke.

Among them, neurologist Stephen Rasmus, M.D., does a quick assessment and orders a CT scan of her brain. If Katie were a real stroke patient, the CT scan would have to be completed and read within 25 minutes of arriving at the hospital, according to the stroke alert protocol.

“The neurologist at that point can actually see the scan as it is being completed and determine if the patient has had a hemorrhagic stroke,” Overton says. “If the patient has had the more common ischemic stroke -- when blood flow to the brain is obstructed -- she may be a candidate for t-PA or Activase. Activase is a clot-busting drug that is given in a timely manner to help break up the clot and possibly reduce or eliminate stroke symptoms.”

While waiting for Lab results, the neurologist continues to reassess the stroke patient and consider whether the criteria fits for using t-PA. He instructs the patient and family on the risks and benefits of receiving t-PA and orders the medication to be prepared. Once lab values are back and in normal range, the medication is administered.

If it were an actual stroke alert, Katie would have been ready to receive t-PA within 43 minutes of entering the hospital -- well within the 60-minute time-frame.

Katie, who is Genesis pharmacist Katie Cinnamon, has received a first-hand perspective of what a stroke patient might encounter.

“The paramedics were very nice and made me feel comfortable, and it was helpful they explained everything so I knew what to expect,” she says. “Once transported to the West Emergency Department, the whole staff seemed alert and read to respond.

“Dr. Rasmus did a great job and was very thorough in his examination. Because there are an overwhelming number of questions asked during the process, I could see how a real patient and his or her family could feel overwhelmed in making a decision on whether or not to give t-PA. Looking back, the questions seemed like a blur, and there were so many processes going on at the same time.”

Overton concludes: “The drill went very well. Everyone was all-hands-on-deck and ready to respond once the ‘patient’ arrived. This drill -- our first mock stroke alert drill -- gave Genesis and MEDIC EMS the opportunity to look for ways to improve the care we provide to the community. We hope to do this type of drill at least twice a year, so we can better evaluate the community’s and hospital’s response.”

The entire mock stroke alert process illustrates how knowing the warning signs of stroke -- and acting quickly -- can greatly affect a stroke patient’s chances of survival and level of recovery, she says. “Stroke is a life and death emergency -- every second counts.”