August 22, 2019
PEF members on the front line of rapid stroke response on Long Island
BY KATE MOSTACCIO
The symptoms of stroke can be subtle. Facial droop, an arm drifting down weakly when someone is asked to raise it. Slurred speech. It’s important for family, friends and even strangers to act fast and recognize “FAST” symptoms. FAST stands for Face, Arm, Speech and Time and it’s how the state Department of Health reminds New Yorkers of key stroke facts.
If you call 911 and you live in Suffolk County on Long Island, highly specialized stroke care could be rolling your way with the recent addition of Mobile Stroke Units (MSUs) to Stony Brook University Hospital’s fleet, strategically based at exits 57 and 68 on the Long Island Expressway.
Skilled PEF members are among those that staff these life-saving units seven days a week.
These MSUs are game-changers with the ability to deliver trained staff, specialized diagnostic equipment and capabilities, and telemedicine conferencing with Stony Brook stroke neurologists within minutes of a 911 call.
“Time is brain,” RNs Heather Bauerle and Juan Serna, both PEF members who staff the MSUs, said.
“If you have a stroke, you don’t always know you’re having one,” Bauerle said. “You often have to rely on someone else to find you, or get worried about you. The time that takes, the time the ambulance takes to arrive, the time it takes to be transported to the hospital, the sometimes-long ER waits. That’s all time that your brain is literally dying. We’re saving brain tissue.”
Bauerle, an RN since 2015, who came up through the accelerated program at Stony Brook and completed an ER fellowship, says it’s often difficult for those not in health care to recognize that someone is having a stroke. “In addition to working our regular shifts, we go out in the community and raise awareness of strokes and associated symptoms,” she said. “It’s very rewarding.”
Serna said stroke is one of the leading causes of death in the country. “One of the reasons why we’re using these units is that people don’t seek care in a timely manner,” he said. “By having the MSU deploy into the community, we’re hoping to reach those patients sooner. Two million brain cells die every minute that you’re having a stroke.”
Strokes occur when oxygen-carrying blood is blocked from reaching the brain and brain cells begin to die, according to the state Department of Health (DOH) website. There are three types of stroke: ischemic, where a blood clot blocks a blood vessel in the brain; hemorrhagic, where a blood vessel bursts and leaks blood into the brain; and transient ischemic attacks, or TIAs, when stroke symptoms last for a short time. TIAs can be a warning sign of a future stroke. The American Stroke Association estimates 87 percent of all strokes are ischemic.
Trained PEF staff are able to utilize specialized equipment on the $1 million MSU vehicles to diagnose and treat stroke patients right outside their homes. “We’re responding right away,” Bauerle said. “We can treat them as if they were in the hospital at that moment.”
Serna said in addition to performing immediate CT scans, the MSU crew can also administer clot-dissolving tPA medication. According to the DOH, the medication is time sensitive — the sooner it’s given, the better — and it will raise a patient’s chances for a full recovery by allowing blood and oxygen to flow to the brain.
Serna recalls a patient on the North Shore, whose son works in EMS. The MSU was dispatched, went to her home and in the driveway was able to perform a CT scan, teleconference with a neurologist back at Stony Brook, administer medication, and ultimately treat the patient for her stroke.
“We gave her medication right in her driveway,” Serna said. “Then we transported her to the nearest stroke hospital. By the next day, I heard she was doing very well. We’re making a difference in the community. Being able to provide that high level of care in the community and being able to bring patients to a comprehensive stroke center. It saves brain.”
The MSU units require additional training to drive, as PEF EMT Patrice Babian can attest. An EMT for five years, two of which have been at Stony Brook, Babian received specialized education that included maintenance and stabilizing the vehicle to facilitate delicate CT scan requirements.
“Primarily I drive the vehicle and stabilize it for the scans,” Babian said. “I’m also a helping hand for the team for whatever else needs to be done.”
Sometimes that means interacting with worried families outside the ambulance. “I try to calmly explain what we’re doing,” she said. “What the possibilities are. How the truck works. A lot of people don’t know the different types of strokes so I can explain that to them.”
This on-the-spot care is inspiring and rewarding. “Seeing the results of our actions right away is the best thing,” Babian said. “Being able to diagnose and fix the issue. Being able to see what’s happening right then and there is the best part. And having the family be so thankful.”
EMS crews ordinarily drop their patients off and move on to the next, she said. With MSU patients, “we’re seeing the results of our actions right away,” she said. “It’s the coolest thing ever and hopefully we can get more of them to help more people.”
Paramedic Andrew Isolano, who has spent two of his five years as a paramedic at Stony Brook, said paramedics on MSU crews have critical care certifications. But, in addition to that higher level certification, Stony Brook took their training a step further. “Stony Brook provided stroke education prior to rolling these trucks out into service,” he said. “We sat down with neurologists in a classroom-type setting and we performed mock simulations, all before the trucks rolled.”
Like Babian, Isolano’s role is to run the EMS side of calls. “We have a lot of staff on the truck not used to being out on the streets collaborating with the local departments,” he said. “Paramedics take charge on the preliminary contact with the patient and work with the nurses to triage the patient and make sure our resources are necessary for that patient.”
The MSU program is improving outcomes for patients, Isolano said. “It’s going to really affect a lot of people in really great ways,” he said. “It already has. There could be a clot somewhere and if it stays there for too long, whatever deficits you may be having like partial paralysis, the longer the clot remains, the more permanent those deficits are going to become. For us to get there sooner, people can be walking away with little to no deficits at all. Timing in stroke care is what is going to determine quality of life.”
Being involved in the program is an honor. “I’m proud that I get to be a part of a program that is front line and cutting edge,” Isolano said. “To be a paramedic and be able to participate in this level of care is really great. To work in this capacity with a nurse and a neurologist on the teleconference — I’m proud to be part of something bigger.”
While not a PEF member, an integral part of the MSU teams are the CT techs. Andrew Adams, a United University Professions (UUP) member who has been with Stony Brook for 15 years, takes over once the nurse onboard does an initial assessment and the neurologist at the hospital deems it necessary to do a CT scan.
“My role is to get the CT scans done and get the images to the radiologist and the neurologist as quickly as possible,” Adams said. “It’s our responsibility to notify the radiologist as soon as imaging is complete.”
Adams said it’s a mobile stroke emergency department coming to the patient saving time and brain cells. “If you get there in time, you can change their life dramatically from the plausibility of the rest of their life in rehab, to now having a significant prospect of continuing their life with family.”
Having the scanning technology on the MSU, along with the neurologist’s real-time assessment through telemedicine, allows them to bring the patient to the right hospital immediately, including bringing them directly to a Comprehensive Stroke Center where life-saving procedures can be done. This avoids going to the local hospital and waiting sometimes hours to be transferred for these advanced procedures.
“I think it’s a really good thing,” Adams said. “I feel it’s where technology is trending anyway. It’s exciting to be a part of something new.”
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