Country folk have always known they have the good life, and now it's getting better. Thanks to a program developed by neurologists at the Medical College of Georgia, stroke patients in rural communities can be assessed by a neurologist and prescribed treatment via a wireless internet program.
The program, called Remote Evaluation for Acute Ischemic Stroke, or REACH, enables neurologists at MCG to view the patient via a web cam, speak with the patient over a cordless telephone, view computerized tomography (CT) scans via wireless internet, then consult with the attending physician in McDuffie Regional Medical Center.
Dr. Louise Yates demonstrates the REACH system.
Photo by Jason B. Smith
"The equipment is very simple, it's a good idea. It couldn't be done 10 years ago when we didn't have this technology," said Dr. Louise Yates, in the Emergency Medicine department at McDuffie Regional Medical Center. "The web cam to me is like something off of a James Bond 007 movie, it's phenomenal."
The Food and Drug Administration has approved tPA, a clot-dissolving drug, as treatment to minimize brain damage in stroke patients. Yet tPA is given to less than 5 percent of patients because they cannot be rapidly evaluated by a neurologist. According to Dr. David Hess, chair of MCG Department of Neurology, tPA must be given within the first three hours after symptoms begin.
Dr. Yates said many patients wait one or two hours before they realize their symptoms are real enough to drive to the hospital. If they live one hour away, then it is too late for the tPA treatment to be effective. Before the REACH program, ambulance drivers who picked up a stroke patient would not even take the time to stop at the MRMC, but would drive straight to MCG in Augusta, she said.
Although the FDA suggests treatment within three hours of symptoms, Dr. Hess said evidence suggests the benefit is even greater within two hours. "The earlier the better" approach is the goal of REACH, he said.
Since piloting the program in March 2003, MRMC, in collaboration with MCG, has evaluated 45 patients with the REACH system. Dr. Yates said 13 of these were treated with tPA, and experienced "significant improvements."
"Now if patients come into McDuffie, the care is as good as anywhere in the country because the doctors and nurses are very well educated about stroke. They counsel with us appropriately, we consult with them about what to do," Dr. Hess said. "I would venture to say that McDuffie treats more patients with tPA than any other hospital of that size. It's almost unheard of for a hospital with less than 75 beds to have given that many tPA treatments."
Jane Lloyd, registered nurse at McDuffie hospital, likes to tell the success stories of the patients who received tPA treatments. She remembers one patient who couldn't raise their leg while laying on the stretcher, then was sitting up "Indian-style" 20 minutes after receiving tPA. Ms. Lloyd also remembers when the neurologist was at a convention in San Diego, and was able to evaluate a patient using his laptop.
"It doesn't matter if you have your stroke on a weekend or on a holiday or in the middle of the night, they can always get us, the system is always up and running. (McDuffie has) done a great job from the administration all the way down, the doctors in the ER are great... all the doctors down there are excellent," Dr. Hess said. "They have a stable staff in the emergency room, so there's not a lot of turnover and we've gotten to know them and they know us. If I had a stroke, and I had to go to a small hospital in this country, you know, I'd rather go there."
Dr. Yates said treatment of tPA is not always needed, and causes risks if given unnecessarily. She said doctors at McDuffie rely on the experience of neurologists at MCG, where they read CT scans every day. She describes the REACH system as "telemedicine at it's best."
McDuffie Regional Medical Center was the pilot hospital for the REACH program. Now the system is also used in Wills Memorial Hospital in Washington, Jenkins Hospital in Millen, Emanuel Hospital in Swainsboro and Washington Hospital in Sandersville. The REACH system is exclusive to Georgia. Dr. Hess said they are trying to implement it in South Carolina, but the MCG neurologists have to get medical licenses for that state.
According to the American Stroke Association, the warning signs of stroke are:
Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause