Day Kimball Healthcare sponsors stroke conference

By Denise Coffey - Staff Writer
Regional - posted Mon., Feb. 21, 2011
(L to R) Day Kimball's Coordinator of Emergency Services, Steve Wexler, M.D., EMS Coordinator Ralph Miro, RN and stroke physician coordinator Majaz Moonis, M.D. Photo by Densie Coffey.
(L to R) Day Kimball's Coordinator of Emergency Services, Steve Wexler, M.D., EMS Coordinator Ralph Miro, RN and stroke physician coordinator Majaz Moonis, M.D. Photo by Densie Coffey.

Day Kimball Hospital hosted a stroke conference on Thursday, Feb. 17, at the Raceway Restaurant in Thompson.  Stroke physician coordinator Majaz Moonis, M.D. from the University of Massachusetts Medical School, Ralph Miro, RN and EMS Coordinator at Day Kimball, and Steve Wexler, M.D. and Director of Emergency Services at Day Kimball Hospital, spoke to the group of nearly 100 about the need for coordination of services between teams in the field and the medical teams at Day Kimball and UMass Memorial Medical Center.

Moonis gave the keynote address on stroke awareness. He underscored the importance of recognizing and assessing stroke patients and getting them to the hospital for treatment as soon as possible. Strokes occur when the blood supply to the brain is blocked or severely diminished. Stroke is the third leading cause of death in the United States and the leading cause of disability in adults in the U.S.  Determining the type of stroke is the first step in determining the appropriate treatment for it, said Moonis. Time is crucial in treating stroke victims successfully. Strokes can affect one region of the brain initially, but the area around that region needs to be addressed quickly, warned Moonis. He said the objective is to assess the patient as quickly as possible, looking at the sudden onset of key unilateral symptoms such as slurring of speech, facial asymmetry, weakness or drift in the arms. If any one of these indicators is present, you want to treat this as a possible stroke victim, he told the audience. Good stroke care starts in the field with the EMT’s who are first on the scene.

Day Kimball’s EMS Coordinator Ralph Miro spoke about the need to combine the rapid assessment in the field with a rapid assessment at the hospital in order to move as quickly as possible in treating stroke victims. There are 750,000 stroke events a year, resulting in 157,000 deaths a year. It all adds up to 65 billion dollars in costs, said Miro. He asked his audience a series of questions in order to get them thinking of how best to treat a possible stroke victim.  Treating in the field is a lot different than treating in the hospital, Miro acknowledged. In order to decrease the impact of a stroke on a patient, he reminded them to do a rapid identification of stroke factors. Untreated strokes that don’t kill can leave patients with a much lower quality of life.  “You want to move this person as quickly as possible,” he said. “You want to make this a seamless transition to a hospital phase.”

Miro reviewed a list of critical pieces of information that a first responder should gather from a patient in the field. It was the kind of information that an ER nurse would need to know when that patient was brought in. EMS is a critical link between the patient and the hospital, Miro said. It is a critical component in educating the community about the severity of strokes and the need for rapid treatment.

Coordinator of Emergency Services at Day Kimball Steve Wexler spoke about linking the EMS community with Day Kimball Hospital and the neurologists at UMass Medical Center. If an EMT suspects that a patient has suffered a stroke, he can request “medical control.” This call sets in motion a stroke alert at Day Kimball Hospital. Staff from a variety of departments including the lab, IT, radiology, patient access, transport and emergency medical services is alerted.  Within a short time period of time after receiving that call, Day Kimball must perform 45 functions, including examination, lab tests, CT scans, and readings, in order to assess the patient further. One of those final functions would be to start an IV drip and transport the patient to UMass Memorial Hospital for complete care.

Day Kimball should receive its accreditation within a month and will eventually become a stroke center. With limited resources, community hospitals are not ideal treatment facilities for stroke victims. With quick assessment in the field by EMT’s, coordination with Day Kimball Emergency Medical Services and transport to UMass Memorial Hospital, the patient’s outcome will be better. 

Wexler reiterated how important it was that EMT’s make the call to the hospital if they suspect stroke. “It’s fine to muster the stroke team,” he said. “I’d rather muster the stroke team and celebrate than be unprepared for the event.” The EMS provides a critical link in stroke care, he said. Without the EMS component, patients don’t do as well surviving stroke events.

If the patient fits into the stroke protocol, a teleneurology monitor is positioned at the patient’s bedside. It will allow a neurologist from UMass to be at the patient’s bedside. The neurologist can perform her own stroke scale and make decisions about the best treatment options for the patient.  


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