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Pre-Hospital Stroke Alert Protocol Study Launched to Speed Treatment

In stroke care, time equals brain cells. Getting a stroke patient the proper treatment swiftly can save lives and prevent severe disability.

A Capital Health study is working to get stroke patients diagnosed even before they reach the hospital, creating a system that speeds diagnosis and treatment.

While paramedics and EMTs can currently provide pre-hospital notification that a patient is exhibiting signs of stroke, this initiative goes further. Capital Health has trained its emergency response personnel to identify and call appropriate stroke alerts in the field. This immediately triggers a process at the hospital’s ER, enabling the patient to bypass triage and be streamlined to the CT scan for diagnostic imaging.

The study involves training more than 100 of the healthcare system’s paramedics and EMTs in Advanced Stroke Life Support (ASLS), a program developed by the Gordon Center for Research in Medical Education at the University of Miami. Capital Health trainers were also recently approved by the University as the first outside organization permitted to begin a program to directly “train the trainer,” thereby expanding this life-saving training. Early study data has shown an increased accuracy in stroke diagnosis by these ASLS trained personnel.

Bypassing triage is expected to reduce the time between when an eligible patient arrives at the hospital and when an intravenous clot busting medication (tPA) can be administered. Known as “door-to-needle time,” preliminary study results are very positive after the studies’ first six months. In fact, average door-to-needle time has dramatically decreased by 40% — from 75 minutes down to 45 minutes.

“We are continually looking at how we can improve and expedite care for patients when it comes to time-sensitive brain conditions like stroke,” said Dr. Erol Veznedaroglu, chairman of the Department of Neurosurgery at Capital Health and director of the Capital Institute for Neurosciences. ‘Two years ago, we opened the country’s first and only neurologically focused emergency department, and door to needles times dropped. Under this protocol, we are already seeing patients receive clot busting medication more quickly, some in under 30 minutes.”

“Anything we can do to shorten the window for treatment of these patients is absolutely invaluable,” saidDr. Mitch Rubin, director of neurology at Capital Health and its Institute for Neurosciences. “Every single minute counts and can have an impact on the ultimate outcome for the patient.”

Eligible patients suffering a stroke can receive IV tPA within 4.5 hours after the onset of witnessed stroke symptoms. This “clot busting” medicine is used in eligible patients with ischemic stroke, where a clot blocks blood flow to or within the brain. This blockage results in the loss of brain cells.

Capital Health is one of the few hospitals to study pre-hospital stroke alert use, and study investigators plan to publish the data with the goal of changing best practices.

Capital Health’s neurosciences program serves as a regional referral source for more than 80 hospitals in the tri-state area and beyond treating more patients requiring brain surgery – and more aneurysms – than any other hospital in New Jersey. They were one of only 8 hospitals nationwide – the only hospital in New Jersey, Pennsylvania, and Delaware – to be honored by the Joint Commission as a 2011 Top Performer for Stroke.

Capital Health is a leading provider of the most sophisticated stroke and cerebrovascular care available. A Joint Commission accredited primary stroke center, Capital Health offers a highly specialized team trained in complex brain disorders and the most advanced procedures offered for the care of patients with strokes, aneurysms, and brain tumors, among other conditions.

Capital Health Regional Medical Center is a State of NJ designated comprehensive stroke center, and the new Capital Health Medical Center – Hopewell is a State of NJ designated primary stroke center. Capital Health was the first hospital in the country to use the clot retrieval device, TREVO, both during its investigation phase and following FDA approval.

The hospital offers one of the largest closed neurosurgical intensive care units in the region. Two years ago, it opened the country’s first Center for Neurologic Emergency Medicine at its Regional Medical Center, a dedicated emergency program for patients requiring emergency care involving the brain, spine or central nervous system.

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