Increasing Access to Quality Stroke Care

People who suffer a stroke, or believe they may be experiencing a stroke, need help fast. The faster a patient can access specialized stroke care, the better their chance of recovery. Getting to a hospital as quickly as possible is extremely critical. Not everyone, however, lives close to a hospital where specialized care is available. Labrador-Grenfell Health is working with several partners provincially and nationally to standardize and enhance stroke care services for residents of Northern Newfoundland and Labrador.  The result is a Telestroke Strategy which uses advanced technology to increase access to quality stroke care.

The following information provides an overview of stroke and outlines the key elements of a Telestroke Strategy adopted by Labrador-Grenfell Health.

What is stroke?
  • Stroke is caused by an interruption of blood flow to the brain tissue due to a clot or a rupture of the blood vessels of the brain.
  • Without blood, brain cells die. Since two million brain cells die each minute during a stroke, the risk of disability and death increases as time passes.
  • Almost 85% of strokes are caused by a blood clot in the vessels supplying blood to the brain.
What are the signs of stroke?
  • Numbness or weakness on one side of the body or face.
  • Difficulty speaking
  • Blurred vision
  • Sudden headache
  • Dizziness or weakness
What to do if you believe someone is suffering a stroke?
  • If you experience any of these signs or symptoms, call the ambulance immediately.
  • Paramedics have been trained to assess and identify the signs and symptoms of stroke.
  • They can transport you to the nearest stroke centre.
  • Under the direction of Provincial Medical Oversight (Paramedicine Medical Transport) and in consultation with the Provincial Stroke Strategy, a Stroke Direct Transport Protocol was implemented.
  • In consultation with a physician through Online Medical Oversight, paramedics may bypass the nearest health care facility to transport a patient to a designated stroke centre as quickly as possible.
Where are the designated stroke centres? Stroke centres have been selected as meeting the all best practice conditions to treat stroke.  In the Labrador-Grenfell Health region, the designated stroke centres are:
  • Charles S. Curtis Memorial Hospital, St. Anthony
  • Labrador Health Centre, Happy Valley-Goose Bay
  • Captain William Jackman Memorial Hospital, Labrador City.
What happens at a designated stroke centre?
  • A full emergency assessment may involve a CT scan and, if appropriate, administering a clot-busting drug called tissue plasminogen activator (tPA).
  • This drug must be given within a few hours of the onset of symptoms. When stroke is caused by a blood clot, treatment with tPA can reverse the effects of stroke.
What is telestroke?
  • Telestroke is the use of telemedicine specifically for stroke care.
  • Advanced videoconferencing technology and cameras extend the reach of the country’s stroke experts to remote communities.
  • Neurologists and radiologists in larger centres can now assist physicians in rural hospitals with the decision of whether or not to administer tPA.
  • Telestroke allows for real-time assessment and management of all stroke patients. Neurologists can see the patient, discuss their symptoms, review the physical findings, and assess images from a CT scan.
What are the benefits of telestroke?
  • Improved access to best practice stroke prevention and care.
  • More ischemic strokes are treated with tPA, more quickly, reducing subsequent brain damage.
  • More strokes are prevented as a result of increased access to secondary prevention services.
  • Patients have lower acute care costs, as well as lower long-term health and social support costs.
  • Use of the country’s limited number of stroke care specialists is optimized and the impact of their knowledge and experience is increased.
What is happening in Newfoundland and Labrador?
  • Telestroke services started with a pilot project in the Eastern Health region which linked physicians in Carbonear with neurologists in St. John’s.
  • Funding provided by the Canadian Stroke Network helped expand the initiative into a provincial program.
  • Under the program, remote sites located in St. Anthony, Happy Valley-Goose Bay and Gander are now connected to St. John’s , improving access to timely tPA treatment.
In conjunction with its partners, Labrador-Grenfell Health will evaluate its telestroke practices and services on an ongoing basis to continue to improve the service it delivers. For further information, click on the following links: Implementing Telestroke in Canada: Canadian Stroke Network