When Treated Like Seriously Injured Car Accident Victims, Stroke Sufferers In Rural Areas Receive Prompt Emergency Care

February 04, 1999

NASHVILLE, Feb. 4 -- Helicopter transport already helps save the lives of car accident victims and, according to researchers, it could help save stroke victims as well.

"If you're involved in an automobile accident and your injuries are severe enough, you're transported to the closest hospital trauma center," says Scott L. Silliman, M.D. "Why not do that for stroke?"

Silliman tested this concept in eight rural counties with a total population of 225,000 in northeastern Florida and southeastern Georgia. His findings, presented today at the 24th American Heart Association International Conference on Stroke and Cerebral Circulation, suggest that the same emergency helicopter system that transports automobile accident victims in rural areas also can help save stroke patients. By getting people to the hospital emergency room in time, stroke patients can receive drug therapy that can save lives and reduce disability.

Previous studies have shown that the drug TPA (tissue plasminogen activator) can dissolve blood clots that block arteries leading to the brain and cause what are known as ischemic strokes. However, TPA must be administered within three hours after a person develops stroke symptoms for the drug to be safe and effective.

Silliman, assistant professor of neurology at the University of Florida and lead scientist of the study, and his colleagues evaluated whether helicopter transport can bring more stroke victims to the emergency room within three hours after onset. They also wanted to determine whether the emergency medical personnel could accurately spot people who had suffered strokes and who therefore needed the emergency ambulance transport, or, says Silliman, "were we getting 5 percent strokes and 95 percent other things?"

"We found we were actually getting patients here, on average, at 107 minutes after symptom onset," says Silliman, director of the comprehensive stroke program at the University Medical Center in Jacksonville, Fla., an institution affiliated with the University of Florida. The medical center's helicopter system, originally designed to transport automobile accident victims, was used in this study. Patients transported to the medical center's emergency stroke unit required round-trip flights ranging between 24 to 96 miles, with the average flight covering 66 miles.

Before an individual can be treated with TPA, he or she must undergo an examination to determine whether a stroke has occurred and whether it was caused by a blocked artery to the brain. The medical staff and equipment needed for this evaluation are hard to find in rural areas, says Silliman.

Of the 39 patients transported, five received TPA. The other patients did not because they had suffered brain damage from an intracranial hemorrhage, caused by a burst or leaking blood vessel; a ministroke called transient ischemic attack (TIA), which is a very mild stroke; or for other reasons. Six of the transported patients did not have any form of stroke.

Of the five TPA-treated patients, all survived. Two had an excellent outcome after receiving the medication; two had a moderate deficit; one had a major deficit, Silliman says.

Many of the stroke survivors who did not received TPA benefited nonetheless from being transported to the comprehensive stroke medical center, Silliman says. For example, patients with intracranial hemorrhage could undergo surgery to repair the bleeding in their brain. Most rural areas don't have a neurosurgeon, he notes.

"Patients with mild strokes had the advantage of having their condition evaluated at a specialized center," adds Silliman. "There is accumulating data that patients who are treated in a stroke unit, as compared to being admitted to a medical floor, have a lower incidence of medical complications and lower mortality in the long run," he says.

The finding that only 6 of 39 patients transported did not have some form of stroke-related problem indicates emergency medical personnel should be better trained to assess stroke symptoms, Silliman adds.

After officials of the eight counties expressed interest in participating in his proposed program, Silliman, with the aid of several others, devised a checklist for assessing whether an individual should be transported to the stroke center and then trained county emergency medical personnel in using the checklist. Now, if someone meets the criteria for transportation, ambulance crews call directly for helicopter transport and drive the patient to prearranged pick-up points for the flight to Jacksonville.

It is certainly applicable to metropolitan areas in the United States that are surrounded by rural areas, like in the upper Midwest, the Southeast, and parts of the West, he adds.

The counties involved in the project are Baker, Bradford, Clay, Nassau, Putnum, and Union in Florida, and Camden and Charlton in Georgia.

Co-authors are Patricia Riley, R.N.; Vicki Huggett, R.N.; and Ken Hanson, M.D.
Media advisory: Dr. Silliman can be reached by phone at (904) 549-7169 or by fax at (904) 549-6562. (Please do not publish numbers.)

American Heart Association

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