Ashtabula County Medical Center | ACMC Pulse | Winter 2020-21

ACMC Pulse • acmchealth.org 9 emergency medical services personnel to begin the stroke assessment and to launch the internal stroke protocol. After an initial assessment, the patient will be sent for a CT scan or a CT angiography of the brain and neck to determine the nature of the stroke and the patient’s eligibility for recombinant tissue plasminogen activator (rtPa). The median time for door-to-CT scan at ACMC is 24 minutes. The national average is more than 34 minutes. “We established our stroke protocols several years ago, with a focus on response time,” said Imraan Haniff, MD, Medical Director of the ACMC ED. “We know that long-term and permanent brain damage increases as more time passes from the onset of symptoms to treatment.” The stroke protocol is a set of evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. The protocol also includes educating the patient and scheduling a follow-up visit before the patient is discharged from the hospital. Time is of the essence ACMC received the Target: Stroke Elite Honor Roll award by meeting quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or alteplase, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. ACMC’s median time to a patient receiving the alteplase medicine is 50 minutes. The two stroke awards average for hospitals not using American Heart Association guidelines is 70 minutes. “Time is essential for patients having a stroke,” said ACMC Neurologist Preetha Muthusamy, MD. “Though American Heart Association 2019 guidelines allow rtPa administration up to 41/2 hours from stroke symptom onset, the benefits are much stronger when the medicine is administered within three hours from symptom onset. In fact, rtPa administration within three hours from symptom onset has been shown to increase chances of functional independence at three months by one-third.” Imraan Haniff, MD Preetha Muthusamy, MD