David Bullock’s stroke occurred on a hot June day as he climbed the steps to his family’s crop-dusting business. His wife, Shannon, an EMT II, witnessed the fall, rushed to his aid and called 911.
An ambulance arrived in less than 10 minutes, and the DeWitt Hospital, about 1.5 hours from the University of Arkansas for Medical Sciences (UAMS), was linked to a UAMS stroke neurologist using high-speed two-way video communication.
Despite having a severe stroke that was later complicated by four subsequent seizures, Bullock went home from UAMS two days later with no discernable, lingering effects.
AR SAVES
Bullock was the beneficiary of AR SAVES (Arkansas Stroke Assistance through Virtual Emergency Support), a UAMS-led telemedicine program to improve stroke outcomes statewide. Established in November 2008, the program removes the barriers to timely care thanks to partnerships that involve the UAMS Center for Distance Health, Arkansas Department of Human Services, Arkansas Department of Health and Sparks Regional Health System in Fort Smith.
So far, AR SAVES has 28 community hospital partners, including Johnson Regional Medical Center in Clarksville, Ark.
Overcoming Barriers
Prospects for a full recovery from stroke improve significantly when patients receive tissue plasminogen activator (t-PA), the powerful clot-dissolving drug. AR SAVES was established to overcome the major obstacles to t-PA’s availability: a 4.5 hour window for t-PA to be given after the first signs of a stroke and a lack of public awareness about stroke.
AR SAVES connects patients who arrive at their local hospitals to one of the five stroke neurologists who are part of the AR SAVES team. The stroke neurologist can then advise whether the patient should receive t-PA.
Timely Connection
With live two-way audio/video, and with assistance from DeWitt Hospital staff, the stroke neurologist determined that Bullock’s stroke was large and severe, something that wouldn’t have been evident if just relying on a telephone conversation.
Stroke Pathway
For a stroke as large as Bullock’s, t-PA isn’t enough, so the stroke neurologist urged his immediate air transport to UAMS and simultaneously activated UAMS’ “stroke pathway,” which ensures that UAMS subspecialists and staff, imaging devices and procedure room are ready when the patient arrives.
Bullock, who arrived at UAMS within about two hours of his stroke, needed an aggressive treatment that could be provided only by one of UAMS’ interventional neuroradiologists – in this case, Eren Erdem, M.D., who is internationally known for his advanced catheter-based treatments.
Subspecialty Care
Erdem used the Penumbra device, one of the latest devices for retrieving blood clots that works by fragmenting and sucking the clot. Bullock’s clot was affecting two-thirds of his left hemisphere, but Erdem was able to open the vessel and restore blood flow before extensive damage occurred.
For Julie Hall-Barrow, Ed.D., program director for AR SAVES and education director for the UAMS Center for Distance Health, the case illustrates the life-saving power of telemedicine, even for patients who ultimately must be transported for subspecialty care that is available in Arkansas only at UAMS.
“Everything went perfectly,” Hall-Barrow said. “You can’t hope for a better outcome.”
David Robinson, senior writer for the University of Arkansas for Medical Sciences.
