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Melanie Cole (Host): According to the American Heart Association, stroke is the number five cause of death and a leading cause of adult disability in the United States. Over the years, great strides have been made in the treatment of stroke and what were once lasting effects, can often be combatted when timely treatment is sought. That’s why the Lourdes Stroke Center delivers innovative state of the art care to patients with symptoms of stroke. My guest today, is Debbie Gillen, she is a Stroke Sepsis Coordinator at Lourdes Health System. Welcome to the show Debbie. So, let’s just start with the basic definition of stroke. What is it?

Debbie Gillen MSN, RN, CMSRN (Guest): Stroke is where there is a blockage or a break in a blood vessel in the brain and the blood is not perfusing areas of the brain, which leads to disability.

Melanie: So, are there certain people that would be more at risk for stroke?

Debbie: Sure, there are risk factors; high blood pressure, heart disease, smoking, diabetes, are all risk factors for stroke.

Melanie: So, if somebody is thinking that they might be suffering a stroke; there is a certain acronym FAST that is used and time is so important that they get into a stroke center to really get care as quickly as possible. Tell us what is a stroke center?

Debbie: A stroke center is a hospital that is able to care for stroke, acute stroke and have the availability to provide TPA and advanced treatment for stroke patients.

Melanie: So, what does it mean if a stroke center is certified and what kinds of organizations offer the stroke center certification?

Debbie: So, one of the stroke certifications is approved by the New Jersey Department of Health and in order to meet those criteria, we have to have services 24 hours a day, seven days a week. We have to have neurosurgery and neuro intervention capabilities. We also have to report on our outcomes and findings for these patients as well as following the American Heart and American Stroke Associations core measures and guidelines.

Melanie: So, hospital teams that commit to earning this primary stroke center certification are supported by tools and resources, accesses to the program representatives who can answer those questions such as yourself. What kinds of tools and resources are we looking at?

Debbie: We provide patient education. We provide community education. We really try to start in the community if our patients aren’t aware of what a stroke is or the signs and symptoms of stroke then they are not going to get here for appropriate treatment. So, our program really starts in the community with patient education out in the community as well as EMS education and then we follow the patient through to make sure that they have the appropriate rehab as well as all of the interventions during the acute phase.

Melanie: And what about the families Debbie, because this is a scary thing to have happen to someone you love. How do you help the families understand what’s going on, what the treatments might be and what the after effects are based on if they got in there soon enough?

Debbie: Our care for the family starts right with the patient’s first experience in the hospital. Stroke is so sudden that it is very shocking to the family also. So, we work with the families to explain to them what we are doing, as well as what the outcomes are going to be for the patient that we are able to tell and we provide them with the appropriate resources moving forward to help them follow through. We also have a support group that is run by our rehab specialist to assist the patient and the family in their rehab process.

Melanie: When you talk about getting out in the community and really getting people to be aware of the symptoms, which is just what is so important; do you find that people are receptive to this? Do you find that they understand? Because it can be complicated medical issue.

Debbie: We try to keep it simple in the community with the signs and symptoms of stroke, but we are still behind the times in having patients arrive for care in a timely manner. We really want people to know that time is brain, so when they have symptoms, they need to come in. We need to be able to treat them quickly and we are still working with the community to get that word out so that we can better treat stroke patients.

Melanie: What about the team at the Stroke Center at Lourdes? Are they all aware of what’s going on with your outreach and how are they all certified or qualified to be a Stroke Center? Tell us about the team a little bit.

Debbie: So, our team consists of neurologists, neurosurgeons, ED physicians, internal medicine doctors who manage some of the care inpatient, our physiatrists also known as our rehab doctors and our nurses of course. So, we provide education. The requirement for education is eight hours of continuing education in stroke every year for our acute stroke team and then at least four hours of continuing education for our staff that regularly work with stroke patients. We also provide education to every other department in the hospital so that they are aware to be able to recognize stroke should somebody in the hospital be having a stroke.

Melanie: And speak about the coordination of post discharge patient’s self-care and it is certainly recommended based on the recommendations of the Brain Attack Coalition and the doctors that they dealt with, what do you tell patients about that self-care and things that they need to do post stroke so that maybe they can recognize another stroke or possibly prevent it?

Debbie: So, our stroke education post stroke and planning really includes making sure that the patient and the family members recognize the signs and symptoms of stroke. Unfortunately, after you have had one stroke, you are at higher risk for having another stroke. So, we need our patient to be – and family to be aware of the signs and symptoms of stroke and again to seek treatment immediately by calling 911 if they have stroke signs or symptoms. We also work with setting up whatever care they might need post stroke and getting them to the most appropriate type of rehab for stroke patients. We do prefer acute rehab which is the most intense inpatient rehab, if they meet the criteria and that would be appropriate for them. Some of our patients go home with little disability, some go home with home physical therapy, some need subacute rehab services. So, it varies, but we do follow through with their rehab plan which is so important in the care of the stroke patient.

Melanie: So, we have mentioned signs and symptoms a few times but let’s discuss them. When I mentioned that moniker that acronym FAST, what are some of the symptoms that you make the community aware of that they should be on the lookout? Tell us about those signs and symptoms.

Debbie: So, FAST is the acronym for face, arm, speech and time. Face being that they would have an uneven smile, if you asked the person to smile, they might have a droop on one side of their face. Arm, you can ask the person to hold out their arms in front of them and if one droops down that could be a sign or symptom of stroke that they have weakness in one side. Speech, ask them to repeat a simple phrase, do they have slurred speech, do they seem confused. That can be a sign or symptom of stroke. And also, time. Again, time is brain, so we want to think the stroke is a medical emergency and we want to call 911 in order to have that person brought into the hospital for treatment.

Melanie: What can they expect when they get to the hospital? And should they drive themselves or should they call 911?

Debbie: The person who is potentially suffering a stroke should always call 911. There’s a couple of reasons for that. One, we work with our EMS providers to assess for stroke in all patients and also to pre-notify us so if EMS arrives to a patient who is potentially having a stroke, they will call the emergency room and let them know that they have a potential stroke victim. With that, our team is ready to go when that patient arrives to the ER. The other is- there are dangers with patients trying to drive themselves to the ER if they are potentially having a stroke. The stroke could progress, they could put themselves and others at risk by driving, but calling 911 because this is a medical emergency is really the way we want our patients to arrive.

Melanie: So, wrap it up for us in summary Debbie as to what the New Jersey Department of Health’s criteria about a comprehensive stroke center entails, what you really want the public to know about Lourdes Health Center as a stroke certified center.

Debbie: With a certified stroke center, we are able to provide 24-7 services for the most advanced types of stroke, the most severe strokes out there. We do not – we have all the services here at Lourdes in Camden. We do not have to transfer our patients out in order for them to get treatment. Our team is ready 24-7, so anybody who comes in with a stroke, no matter what time, what day of the week, you are going to get the same care. Our neurosurgeons are dually trained as neurosurgeons and neuro-interventionalists so they can do the most advanced stroke treatments here in Camden.

Melanie: Thank you so much for being with us. It is such important information for people to hear. You are listening to Lourdes Health Talk and for more information you can go to lourdesnet.org. That’s lourdesnet.org. This is Melanie Cole. Thanks so much for listening.