Fear can be our friend when it helps us avoid danger. When fear forces
us to take unhealthy risks, however, it can be our foe. Doctors and nurses
working in Southeast Georgia Health System’s Stroke Program know
this all too well.
When the pandemic struck, Phillip P. Amodeo, M.D., a board-certified neurologist
at Southeast Georgia Physician Associates–Neurology and medical
director for the Health System’s Stroke Program, and Cynthia Gahm,
R.N., Stroke Program coordinator, say stroke patients were reluctant to
seek immediate medical attention. “I saw a number of patients who
waited days or a week to come to the hospital after their stroke. We saw
that even before COVID-19, but quite a bit more in the past year,”
says Amodeo. “It’s tragic that some didn’t come sooner
because they were afraid of getting COVID-19. That was a reasonable fear,
but at the same time, they will likely end up with worse long-term disability
from their strokes than if they were treated immediately.”
Timing is Everything
According to the American Heart Association, every 15 minutes that passes
between the onset of an ischemic stroke and the delivery of tPA, a clot-busting
drug, can have debilitating consequences. The patient may never regain
or achieve the function they could have if treatment started sooner. That’s
why Gahm says, “Time is brain! Approximately two million brain cells
die every minute during a stroke. Stroke treatments have the potential
to stop or reverse symptoms, but treatment is time sensitive.” Amodeo
adds, “The more brain cells that are killed by the stroke, the higher
the likelihood of disability.”
To improve patient care and minimize disability, the Health System added
telestroke services to its Stroke Program in 2016. The addition of telestroke
brought videoconferencing technology into the Health System by joining
forces with Baptist Health Jacksonville and additional neurologists in
Florida and Southeast Georgia. Any stroke patient arriving at the Brunswick
or Camden Campus Emergency Care Center is diagnosed within minutes by
a Healthy System physician working with a Baptist Health neurologist,
via video. One of the Health System’s four local neurologists is
also on call 24/7. After assessing and diagnosing the patient, the stroke
team providers guide them through recovery and rehabilitation. The program
has expanded care throughout the region, explains Amodeo. “We receive
patient transfers from Waycross and other smaller hospitals because they
do not have neurologists on staff.”
Since the stroke team first started using telestroke technology, they’ve
seen a 30-minute drop in “door-to-needle” time – the
interval between a patient’s arrival and when they receive tPA.
As a result, patients experienced fewer disabilities. Unfortunately, COVID-19
impacted the timeliness of stroke care with patients delaying treatment.
“Some patients were candidates for tPA, but avoided coming to the
hospital, showing up days after symptoms started,” recalls Amodeo.
In some cases, tPA can be given up to 4.5 hours after symptoms begin.
However, when patients prolong hospital care, the treatment window closes.
“We gave approximately 30% less tPA in 2020 than in 2019,”
When stroke patients arrive unaccompanied, Gahm says it is harder to determine
an exact “last known well” time. “This is crucial information
that’s required before we can order tPA.”
This unnecessary gap in medical care and the associated risk of disability
is why the stroke team urges the public to “BE FAST” and call
9-1-1 if they or someone they know experiences any potential stroke symptoms:
Balance – Watch for sudden loss of balance.
Eyes – Check for vision loss.
Face – Look for an uneven smile.
Arm – Check if one arm is weak.
Speech – Listen for slurred speech.
Time – Call 9-1-1 right away.
The stroke team adhered to hospital and CDC guidelines to contain the
virus, while promoting timely stroke assessment and treatment. “Our
hospital staff and stroke team met regularly to discuss ways to improve
stroke care. We updated policies and protocols to follow best practices.
Our hospital census increased during summer 2020 and we opened additional
units, rooms and beds,” says Gahm.
By continually improving care, the team achieved a major milestone. Despite
the difficulties of last year, 2020 was the first year both hospital campuses
were designated Remote Treatment Stroke Centers by the Georgia Department
of Public Health (DPH). “We applied for Remote Treatment Stroke
Center Designation in January 2020. The DPH reviewed our protocols and
policies – some of which began in 2015 when our program started
– to ensure that we provide quality care. In March 2020, we were
notified that we had earned the designation,” Gahm reveals.
The Health System has also received the American Heart Association/American
Stroke Association’s Get With The Guidelines®-Stroke Silver
Plus Quality Achievement Award. The award recognizes ongoing efforts to
ensure that stroke patients receive treatment aligned with nationally
recognized, research-based guidelines.
Though patients were reluctant to seek care and that sometimes hampered
the stroke team’s ability to provide timely medical attention, they
never stopped trying. Gahm recalls one patient who didn’t come to
the hospital sooner because “he didn’t want to take a hospital
bed from someone who really needed it.” Having seen strokes rob
people of their independence, Cynthia Gahm reminds us, “Strokes
are emergencies, and while symptoms can be mild, they can worsen quickly.
Timely assessment is important in determining the underlying cause and
To support your community hospital, call Southeast Georgia Health System
Foundation at 912-466-3360.