Stroke: Time is brain

Their face starts drooping on one side.
They can’t speak properly or move on one side of their body.
Time to Call 111. Now.  
A clot has blocked a blood vessel in their brain.
They are having a stroke. Time is brain.
The only way to avoid long-term damage is to get to the hospital, quickly.
The good news is that patients have an excellent chance of avoiding disability here in Tairāwhiti.
Gisborne Hospital stroke data from last year shows a dramatic improvement from previous years, according to the 2022 Annual Stroke Reperfusion Report.
Te Whatu Ora Tairāwhiti stroke service lead at Gisborne Hospital, Dr. Erik Rufa says up to 80 people per year have a severe stroke in the region and numbers are increasing.
“We’re extremely happy with the progress we’ve made in treating stroke.  We are identifying it quicker and getting more people the right treatment,” he said.
Data in the report shows the percentage of people getting successful treatment has more than doubled and even tripled compared to recent years, with minimal complications.
“Our goal is for everyone to return to normal life after a stroke and avoid any kind of disability,” he says.
“When someone has a stroke, time is brain. The longer the time to treatment, the more likely the patient is to have permanent severe disability.”
A stroke is caused by a clot in a blood vessel in the brain, and there are two ways to treat it. The first is called Thrombolysis, which involves using clot-busting medication to dissolve the clot. The second is to insert a catheter into the blood vessel and remove it.
“When we are advised that someone is coming to the Emergency Department with a stroke, we need to treat them as soon as possible and success is measured on how quickly we can assess the patient and get them this treatment,” explains Dr. Rufa.
“We have an excellent partnership with the neurology department at Te Whatu Ora Capital and Coast, which gives us 24/7 access to a neurologist who can guide us through the process if assistance is needed.
“Over time this partnership has produced excellent outcomes for our people and the specialists in Wellington now understand our challenges here.
“The real success, however, has been how well our team in the Emergency Department and stroke team can respond.
“We are able to have the patient and our team talking face-to-face with a top neurologist in Wellington by video within minutes of them arriving in ED. This service model is called ‘Telestroke.’”
Professor Anna Ranta is a Wellington Neurologist who pioneered Telestroke in Aotearoa New Zealand and helped set-up the service in Gisborne. 
“Being able to link tertiary specialists to clinicians and whānau with stroke in the smaller regional hospitals is important because treatment decisions are very time pressured and complex,” she said.
“It is a very important step to reduce health inequities.  The Gisborne team has been absolutely fantastic to work with and it is very exciting to see the outcomes that have been achieved.”
Last year, 94% of people who had a stroke here were discharged within 7 days, with no treatment complications.
Dr. Rufa says that while the progress is good news for the Tairāwhiti community, more work needs to be done to raise awareness in the community to prevent stroke.
“Healthy lifestyle changes are the key to stroke prevention, however, mini-strokes (Transient Ischaemic Attacks or T.I.A) are warning signs for a major stroke and our community needs to know how to identify them and see a doctor.
“A T.I.A can’t be ignored, as the chances of having a major stroke after suffering a mini-stroke are much higher. The symptoms of a T.I.A are the same, but they last a short time and then disappear.
“We use the term F.A.S.T. to identify symptoms of a stroke. Facial drooping, Arms – unable to lift one, Slurring speech, Time to call 111.
“If we can treat strokes earlier, the better chance we have of avoiding the serious impacts that are caused in the brain.
“The best chance we have to avoid the serious impacts of a stroke is to treat it early, recognition is key.”

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