Code stroke saves precious minutes

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The morning started out for Robert (Bob) Collins like any other. Bob was getting ready to get coffee when his arm felt strange. “I felt kind of funny – so I leaned against the table,” he remembers. “It seemed to pass and I felt ok.” Bob continued to his bedroom and sat on the bed to get dressed. The next thing he knew he was falling right onto the hardwood floor.

: Bob Collins and his wife Sharon (centre) are joined by Emergency Department RN Jean Durnford and Shelley Hawton, District Stroke Coordinator.
: Bob Collins and his wife Sharon (centre) are joined by Emergency Department RN Jean Durnford and Shelley Hawton, District Stroke Coordinator.

Bob says his first thought was to try and get up. “I couldn’t understand what had happened,” he says. But Bob’s wife Sharon did—and she knew exactly what to do. “I yelled to him to stay where he was and I got the phone to call 911,” Sharon says.

Time is Brain

Shelley Hawton, District Stroke Coordinator at the North Bay Regional Health Centre says Sharon did the right thing by calling 911. “We say ‘time is brain’ because it is estimated that for each minute that passes during a stroke, 1.9 million brain cells die,” Hawton says. “That is why it is so important for people to recognize the signs of stroke, and to call 911.”

The Heart and Stroke Foundation of Canada has adopted the use of the acronym FAST to help people learn and recognize the signs of stroke.

F – Face: is it drooping?

A – Arms: can you raise both?

S – Speech: is it slurred or jumbled?

T – Time: to call 911 right away.

Jim Stewart, Manager, District of Nipissing Paramedic Services says in addition to providing immediate emergency medical care during safe rapid transportation, paramedics are critical to stroke care and essential to help save precious minutes when dealing with a potential stroke.

“There is an expertise our paramedics bring to the critical first moments after a stroke, which is why calling 911 when you suspect a stroke is so important,” Stewart says. “Paramedics across the region are trained to determine if a patient should be brought directly to a stroke centre rather than their local hospital. Also they are notified if the CT scanner is down and can re-route patients to another hospital, potentially saving even more time.”

The paramedics who arrived at Robert and Sharon Collins’ house that morning initiated a Code Stroke.

Code Stroke

Hawton says staff have been working hard to align stroke care at the Health Centre with the Canadian Stroke Best Practice Recommendations. “Most notably is the launch of our Code Stroke process in the Emergency Department in February 2016,” Hawton says.

Code Stroke means hospital personnel and stroke team members are ready to start diagnosis and treatment of a potential stroke as soon as the patient arrives at the Emergency Department. A Code Stroke patient is prioritized for things like lab tests and the CT scanner.

“This new process involves multiple hospital departments who collaborate to ensure patients experience a seamless journey with minimal time wasted,” Hawton explains.

Door to Needle time

TPA is a clot busting medication that can be given to some patients who are experiencing a stroke. The North Bay Regional Health Centre is one of five hospitals in northeastern Ontario equipped to provide the ‘clot-busting drug’ to stroke patients meeting the criteria for the treatment.

Hawton explains door-to-needle time is a term given to the time from arrival to the Emergency Department to the time TPA is given.  “Our aim is to have a door-to-needle time under 60 minutes,” Hawton says. Bob’s door to needle time was 36 minutes.
By the time Sharon arrived at the hospital, the tests were completed and the Emergency Department physician, Dr. Derrick Yates, had contacted a stroke neurologist by video conference who confirmed Bob was a candidate for TPA.

Bob remembers the feeling of paralysis take over his right side. “I couldn’t move at all,” he says, “and it was starting to affect my vision too.”

Time was of the essence—they had to decide quickly if they wanted the TPA. “I looked over at Bob and said ‘do you want this’ and he nodded. So we went for it,” Sharon says.

Jean Durnford, RN was Bob’s nurse while he was in the Emergency Department. Bob says Jean was an important presence to him. “She was the first one I saw as I was recovering,” Bob says. “She was so kind and was able to put me at ease.”

Within half an hour Bob’s paralysis lifted: he could see again, he could move his arm, move his leg, everything. He said it was amazing.

Jean remembers watching the TPA take effect. “He had total paralysis on one side, and to see a complete resolution was so rewarding,” Jean remembers. “It’s nice for us to see cases like Bob’s, it reminds us why we are here.”

Bob says Jean’s excitement was a motivator for him. “Watching her excitement made me feel really good—she inspired me to keep going.”

Recovery

Bob was admitted to the Critical Care Unit (CCU), and is proud to say he was able to walk himself out three days later. “They tell me that doesn’t happen very often,” he says. Now back at home, he works hard at his recovery, participating in the hospital’s outpatient programs.

Bob and Sharon are so thankful to everyone who helped them that day, and actually returned to the hospital to share their gratitude in person. “From the paramedics, Emergency, CCU and physiotherapy staff, my wife and I are so grateful to everyone who helped us with my recovery,” Bob says.

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