Helena Regional Medical Center Joins UAMS-Led Program to Provide Emergency Stroke Care

By David Robinson

Called Arkansas SAVES (Stroke Assistance Through Virtual Emergency Support), the program uses a high-tech video communications system to help provide immediate, life-saving treatments to stroke victims 24 hours a day.
The SAVES program is made possible by partnerships between the UAMS Center for Distance Health, the state Department of Human Services and Sparks Regional Health System in Fort Smith. The program was established with a one-year, $6.1 million DHS Medicaid contract.

Eight other Arkansas hospitals are participating in the SAVES program: Baptist Health Medical Center – Arkadelphia, White River Medical Center in Batesville, Baxter Regional Medical Center in Mountain Home, Booneville Community Hospital, DeWitt Hospital, Johnson Regional Medical Center in Clarksville, McGehee-Desha County Hospital and Mena Regional Health System.

Additional hospitals across Arkansas will be added in the coming months, said Curtis Lowery, M.D., director of the UAMS Center for Distance Health.

“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 medical director and assistant professor of neurology at UAMS.

The most recent statistics from the national Centers for Disease Control and Prevention show that Arkansas had 1,847 stroke-related deaths in 2005, which dwarfs Arkansas’ other major causes of death. Arkansas ranks third highest among all states in stroke deaths, with 61 per 100,000 residents. Only Alabama and Tennessee had a higher number. The nationwide direct and indirect cost of medical and institutional care of permanently disabled stroke victims was $57.9 billion in 2006.

“The Arkansas SAVES program will save lives and money because if stroke patients get the treatment they need within three hours, they have a much greater chance of living without a major, costly disability,” said Julie Hall-Barrow, Ed.D., education director for the UAMS Center for Distance Health. 

While many stroke patients are rushed to their local hospital emergency room, they still are at high risk of death or permanent disability. That’s because emergency rooms aren’t likely to be staffed by a neurologist who can diagnose the type of stroke and whether to treat it with t-PA, the blood-clot dissolving agent used for ischemic stroke. Although potentially life-saving for people with an ischemic stroke, t-PA may be detrimental if the patient has a hemorrhagic stroke, which occurs when a blood vessel ruptures and bleeds into surrounding brain tissue.

Since Nov. 1 when the program began, 27 stroke patients have been treated by specialists in the Arkansas SAVES program, and three have received the t-PA drug.

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 all of the partner hospitals 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 remote Emergency Room 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 ER physician and patient. Together they can determine the appropriate treatment, such as whether to administer t-PA and the correct dosage.

“Short of being able to prevent strokes which should be our ultimate quest, this is the best model program we could use to treat strokes,” Keyrouz said. 
He noted that high blood pressure, diabetes, smoking, age, gender, 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 visual 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 in Fort Smith.

UAMS is the state’s only comprehensive academic health center, with five colleges, a graduate school, a new 540,000-square-foot hospital, 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 the state’s largest public employer with more than 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. Visit www.uams.edu or uamshealth.com.