For Stroke, Care Must Come Fast – This Health First Hospital Volunteer Had One Big Advantage

B.E. F.A.S.T. when you spot stroke symptoms

Allan Gair’s stroke symptoms were spotted at Health First Holmes Regional Medical Center. World-class care was right down the hall.

BREVARD COUNTY, FLORIDA – Allan Gair, 82, has volunteered for Health First for 18 years, and it’s rewarded him in meaningful relationships and discoveries, but it’s never paid off like it did April 10.

At about 1 o’clock he stepped over to the lab to get an ordered blood draw performed, and that’s when an associate taking his registration noticed he was unable to find the words – like his name – to register at the desk. His facial muscles were starting to droop.

Gair doesn’t remember everything – but he remembers “that wheelchair was next to me in a snap, and I had nurses flocking to me.”

He was suffering an acute ischemic stroke with symptoms of aphasia. In a stroke, a part of the brain is unable to get oxygenated blood, commonly because of a clot (ischemic), occasionally because a blood vessel has burst (hemorrhagic). Without oxygen, the affected part of the brain begins to die. At some point, it cannot be revived. Each minute brings permanent damage nearer.

A Modern Stroke Center’s Advantages

Gair’s condition prompted a hospital Stroke Alert. A CT scan of his brain was ordered. A software platform called Viz.ai (the “ai” stands for artificial intelligence) reviews scans in seconds and highlights blockages (a radiologist also reviews all images, whether or not the software selects any). Gair was quickly given Tenecteplase, an intravenous bolus that dissolves the clot and restores blood flow to the brain, just 22 minutes after his symptoms were spotted.

The average time for such treatment is more than 2.5 hours.

Several years ago, an amazing breakthrough happened in stroke medicine. It’s called endovascular thrombectomy (EVT). In it, an interventional neurologist, guided by X-ray, threads a catheter up an artery and into the brain and physically retrieves the blood clot.

Holmes Regional is the area’s only Joint Commission Accredited Thrombectomy Center and has been performing the procedures under the direction of Interventional Neuroradiologist Fawad Shaheen, MD, for about a decade. The Stroke Team’s work has grabbed some headlines.

Within the last three years, Health First has onboarded Viz.ai, artificial intelligence-based software that spots strokes in radiological scans (CTs) and alerts the team by smartphone, with images physicians can study and evaluate for themselves.

In stroke, minutes can mean the difference between recovery and lifelong disability. Viz.ai is one way Holmes Regional is meeting patients’ most urgent needs, but it’s not the only way.

B.E. F.A.S.T. 

All three of Health First’s community hospitals – Palm Bay, Cape Canaveral and Viera hospitals – and Holmes Regional Medical Center have refined their Stroke Alerts to shave minutes, even seconds off. The focus for physicians and directors is something called “door-to-needle time.” That’s how fast stroke patients are given Tenecteplase from the moment they enter the doors of the hospital.

For community hospitals, the average door-to-needle time today is 45 minutes.

Stroke is the leading cause of long-term disability in the U.S., and there are about 800,000 each year. The mnemonic Health First has adopted to help residents spot the symptoms of stroke is B.E. F.A.S.T.:

■ Balance Is you or your loved one unsteady?
■ Eyes Is there vision loss?
■ Face Does the smile look uneven?
■ Arm Is one arm weak?
■ Speech Is speech slurred?
■ Time Time to call 9-1-1.

Don’t discount balance and vision symptoms – the B.and E. – says Whitney Adkins, Health First’s Neuroscience Program Nurse Manager. They’re associated with anterior and posterior strokes, which present in ways often confused with other conditions: 16% of anterior and 37% of posterior strokes are initially misdiagnosed.

And call 9-1-1, don’t settle for driving a loved one to the nearest Emergency Department (and never drive yourself). Paramedics and EMTs are trained to do initial diagnostic tests for stroke while enroute, and if positive, can begin the Stroke Alert process at Health First hospitals.

‘They Care’

Gair spent four nights in an intensive care unit before being discharged, during which he began physical and speech therapy – a regimen that continued after he got out.

Today, the veteran volunteer is back on duty at Holmes Regional – at the Emergency Department, the Surgical Waiting Room, at patient discharge and as a greeter. His best estimate is that he’s given 60,000 hours to the hospital.

“I love this hospital,” says the retired Long Island, New York, elementary school teacher.

“Since I moved down to Florida, I have found that my relationship with doctors is something I never had in New York – they care,” he says. “And I have the same reverence for the nurses here.”

“It is wonderful to see people benefit from our stroke program, and Allan has given so much to Health First over the years that it is an honor and privilege to give back to him,” says Nancy Mettner, Holmes Regional’s System Director for several service lines that include Stroke and Neuroendovascular Surgery. “We have a passionate team that works tirelessly to ensure that state of the art stroke care is given.”

Begin exploring your risk for stroke with Health First’s quick Stroke Risk Quiz, HF.org/Stroke. Visit HF.org/news to keep up on the latest at Health First.

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