HealtH Matters 43
Stroke ServiceS
thrombolytic therapy within the critical
time window of three hours from known
stroke onset (later extended to 4.5 hours
in september 2008 upon presentation of
the eCass III study results).
iMpleMentation, tactics and
strategy
It was recognised from the start that to
ensure rapid pre-hospital prioritisation,
transportation, assessment and treatment
for stroke patients for this very time-
sensitive therapy would require the
co-operation and support of several key
players in the stroke patient’s ‘chain of at the Midland regional Hospital, Mullingar,
survival’, including the ambulance service, can be judged by the fact that 26 of 143 (18
Department of emergency Medicine,
“Since early 2008
per cent) acute ischaemic stroke patients
Department of Diagnostic radiology,
approximately 20 per cent
were treated with intravenous thrombolysis
Intensive Care Unit, all the Consultant in 2008. as of July 14th 2009, a further
Physicians and specialist registrars in the
of the acute ischemic
21 of 90 ischaemic stroke patients (23 per
Department of Medicine at the hospital as
stroke patients in mullingar
cent) had been treated. Overall, since early
well as its nursing staff. 2008 approximately 20 per cent of the
advance planning to achieve the primary had been treated with acute ischemic stroke patients in Mullingar
objective of providing a 24/7 stroke
thrombolysis service began in late 2006.
thrombolytic therapy”
had been treated with thrombolytic therapy.
this is a very high percentage in both
the Consultant Physicians at the hospital national and international terms. Our safety
agreed that henceforth all acute stroke record to date has been excellent. We have
patients would be admitted under the the Department of emergency Medicine had only one symptomatic intracerebral
newly created stroke service to ensure at the hospital, in conjunction with the haemorrhage, no significant extra-cerebral
uniformity of assessment and treatment of Medical specialist registrars, provided haemorrhage and no death related to
acute stroke. In 2007, all 136 Paramedics support for the early and rapid assessment this treatment.
and emergency Medical Dispatchers in of Fast positive patients upon arrival, rapid
the National ambulance service Midland notification of the radiology Department
Division received a three hour training to facilitate emergency Ct brain scan. Acute Stroke Service, Midland
session, relevant to their role, covering the the emergency Medicine Consultant Regional Hospital, Mullingar
importance of stroke, its rapid prioritisation provided logistical and administrative (MRHM), Co. Westmeath: Prof Sean
and recognition in the field using the support to ensure that all emergency Murphy; Dr Clare Fallon; Dr Martin
Medical Priority Dispatch and Face arm Department trainees were aware of Mulroy; Katherine Kenny in partnership
speech test (Fast), the importance of the stroke thrombolysis Protocol and with HSE National Ambulance Service,
rapid transportation of stroke patients to assessment procedures. Midland Division (NASM); Robert
the acute hospital with advance notification Colleagues in the Department of Morton; Brendan Whelan;
of the emergency Department of the Diagnostic radiology enthusiastically Gearoid Oman.
imminent arrival of a Fast positive patient supported the new approach to acute Dept of Emergency Medicine MRHM:
so as to enable rapid assessment and stroke at the hospital and the need for early Richard Lynch; Margaret Kearney.
neuro-imaging. the time critical nature of and rapid neuro-imaging of stroke patients. Department of Diagnostic Radiology
treatment within a 0-3 hour time window the 32-slice Ct scanner also allowed at MRHM: Dr James Slattery; Dr
from stroke onset (later extended to 4.5 selective use of Ct angiography and Hugh Logan; Dr Nazia Amer and Dr
hours) was emphasised. perfusion Ct to be employed in this rapid Maria Jarnikova.
at the same time, the Midland Division assessment process. Intensive Care Unit at MRHM:
was the first in Ireland to upgrade its Dr Ron Charles; Jane Barker.
response to acute stroke to the highest outcoMes HSE Dublin Mid Leinster: Trevor
priority level similar to that provided for the success of this unique integrated O’Callaghan; Carmel Brennan and
acute chest pain and trauma, in other community-hospital acute stroke John Bulfin.
words, ‘blue lights and sirens’. assessment and treatment system based
health matters is 4.indd 43 27/11/2009 20:42:56
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