November 4, 2008

UAMS Leads Statewide Emergency Stroke Response Team to Reduce Death Rate


LITTLE ROCK – A statewide program led by the University of Arkansas for Medical Sciences (UAMS) expects to raise Arkansas’ last-place ranking in stroke-related deaths.


The program uses a high-tech, video communications system to help provide immediate, life-saving treatments to stroke victims 24 hours a day. The program was established with a one-year, $6.1 million Arkansas Department of Human Services Medicaid contract.


Called Arkansas SAVES (Stroke Assistance Through Virtual Emergency Support), the program began Nov. 1 as a partnership between the UAMS Center for Distance Health, the state Health Department, Booneville Community Hospital, Johnson Regional Medical Center and Mena Regional Health System. Sparks Regional Health System in Fort Smith will serve as a hub in the Telestroke system.


Curtis Lowery, M.D., director of the UAMS Center for Distance Health, expects the program will be expanded in 2009 to another six hospitals in southern and north central Arkansas.


“This is an important part of UAMS’ mission – reaching out to rural areas of the state and helping local physicians identify patients with stroke and improve the patients’ outcomes,” said Salah Keyrouz, M.D., the Arkansas SAVES director and assistant professor of neurology at UAMS.


Statistics from the national Centers for Disease Control and Prevention show that Arkansas had 1,948 stroke-related deaths in 2004 alone, which dwarfs Arkansas’ other major causes of death. In addition, the direct and indirect cost of medical and institutional care of permanently disabled stroke victims was $57.9 billion in 2006.


The Arkansas SAVES program is expected to save lives and money because many stroke victims survive without major disability if they receive appropriate treatment within three hours. While many stroke patients are rushed to their local hospital emergency room, they still are at high risk of death or permanent disability. Why? Emergency rooms aren’t likely to be staffed by a neurologist who can diagnose the type of stroke and whether to treat it with TPA, the blood-clot dissolving agent used for ischemic stroke. Although potentially life-saving for people with an ischemic stroke, TPA may be fatal if the patient has a different type of stroke.


The Arkansas SAVES system relies on the state Health Department’s hospital preparedness high-speed video network transmission lines that provide the live, video communication necessary to link an on-call neurologist with a local hospital physician who is caring for a stroke patient. The program has installed telemedicine equipment at the hospital emergency rooms staffed by the participating neurologists, and at their homes. 


As part of the program, first responders in Clarksville, Booneville and Mena have been trained to perform a stroke assessment so that they can alert emergency room doctors before they arrive. Emergency room doctors and nurses also have been trained as part of the program to do a more in-depth stroke assessment upon arrival. Further evaluation continues after sending the patient for a battery of tests, including a CT scan. If the CT scan indicates a stroke, the attending physician will call a special hotline that activates the Arkansas SAVES Telestroke System. The call goes to a nurse staffing the UAMS Call Center who then links – via the video connection – the on-call neurologist with the patient’s attending physician.


The neurologist will have immediate access to lab results, the CT brain image and a real-time, high-definition video/audio connection with the attending physician and patient. Together they can determine the appropriate treatment, such as whether to administer the TPA agent and the correct dosage.


“This is just an incredible step forward,” said Bill McCourtney, M.D., emergency room medical director for Mena Regional Health System who served his residency at UAMS’ Area Health Education Center (AHEC) Northeast in Jonesboro. “Now we can go in and minimize, and potentially completely reverse, the effects of a stroke.”


“Short of being able to prevent strokes, this is the best program we have to treat strokes,” Keyrouz said. 


He noted that high blood pressure, diabetes, smoking, age, high cholesterol and lack of exercise are all risk factors for stroke. It’s also important that the public be aware of the signs and symptoms of a stroke, such as sudden weakness, numbness, unsteady gait and speech problems. 


In addition to Keyrouz, two other neurologists make up the team: James Schmidley, M.D., professor of neurology at UAMS, and Margaret Tremwel, M.D., a  neurologist at Sparks Regional Health System.


UAMS is the state’s only comprehensive academic health center, with five colleges, a graduate school, a medical center, six centers of excellence and a statewide network of regional centers. UAMS has 2,652 students and 733 medical residents. Its centers of excellence include the Winthrop P. Rockefeller Cancer Institute, the Jackson T. Stephens Spine & Neurosciences Institute, the Myeloma Institute for Research and Therapy, the Harvey & Bernice Jones Eye Institute, the Psychiatric Research Institute and the Donald W. Reynolds Institute on Aging. It is one of the state’s largest public employers with about 10,000 employees, including nearly 1,150 physicians who provide medical care to patients at UAMS, Arkansas Children’s Hospital, the VA Medical Center and UAMS’ Area Health Education Centers throughout the state. UAMS and its affiliates have an economic impact in Arkansas of $5 billion a year. Visit