Shore Medical Center Pilot Program with Community EMS Providers Significantly Reduces Stroke Treatment Time

Shore Emergency Department staff presented the results of their stroke pilot project at the 2022 NJ Emergency Nurses Association Emergency Care Conference March 16 - 18 at the Tropicana in Atlantic City. Pictured left to right is Luke Akerlind, RN, Shore Emergency Department Clinical Supervisor; Sherri Richmond, Shore Director of Emergency Services; Carolyn Gattuso, MSN, RN, CNS, CEN, SCRN, Shore Adult & Pediatric Clinical Liaison; James Hillis, RN, BSN, MHA, CCRN Assistant Nurse Manager, Emergency Department and Pediatric Care Center; and from Human Resources, Bill DeJesus, Manager of Employment and Compensation. 

March 17, 2022

This week, hundreds of Emergency Department nurses and clinicians across the country have converged at the Tropicana in Atlantic City for the first in-person NJ Emergency Nurses Association Emergency Care Conference since 2019. It’s a chance for ER nurses to learn, reconnect and reenergize their professional knowledge. After a grueling two years of battling the COVID-19 pandemic on the front lines, these healthcare heroes have a lot to share. 

For the first time, Shore ER nurses are not only attending the conference to learn; this year, they are presenting a poster and sharing what they learned from their 90-day stroke pilot project with local Emergency Medical Service providers. Through this project, they reduced the average time it takes to get a patient from the ambulance into advanced stroke treatment protocols from 12 minutes to an average of 4 minutes - a critical improvement that is saving lives. 

Time Equals Brain
There’s a saying in the world of emergency medicine that “time equals brain.” It means for every minute that goes by during a stroke, an estimated 2 million brain cells will die. A stroke occurs when there is a blood clot or ruptured blood vessel cutting off the blood and oxygen supply to the brain. Without treatment, stroke can lead to permanent disability and even death. In the United States, someone has a stroke every 40 seconds, and every 4 minutes, someone dies of stroke. 

But in many cases, a stroke doesn’t have to be fatal or debilitating if the patient receives timely medical care. For that to happen, quick and expert decisions must be made every step of the way, from the person who notices stroke symptoms and calls 911, to the dispatcher who asks the right questions so the ambulance team is prepared, to the EMT who assesses the patient and transports them to the nearest hospital, and to the ER team who stabilizes and treats them. 

Shore Medical Center is a Primary Stroke Center that was awarded the Joint Commission’s Gold Seal of Approval as an Advanced Primary Stroke Center in 2005, and it has maintained that certification ever since. This certification means that Shore adheres to strict stroke protocols and provides acute stroke care faster and with better outcomes. 

Sherri Richmond, Director of Emergency Services at Shore Medical Center, is proud of the acute stroke team at Shore. They do a great job, and they’re always being proactive to do even more to get patients treated faster. 

The EMT Connection
Richmond has always recognized that the EMTs who bring stroke patients to Shore are critical players in saving brains, but she wanted to do more to embrace EMTs in their Primary Stroke Center program and empower them to play an active role in improving stroke outcomes.  

“EMTs call the ER ahead of time to let us know they’re coming in with what they believe could be a patient with a stroke. But with more stroke knowledge, concise reporting, and better communication, we can get all the information we need from our EMTs before they even get here. With enough information, we can instruct the EMTs before arrival that they’re to bring the patient directly to the CT scanner and bypass registration, saving precious time,” Richmond said.  

To put her theory to the test, in 2020, Richmond and the Shore stroke team, including Rob Schrevelius, Stroke Coordinator, and ER Adult and Pediatric Liaison Carolyn Gattuso, launched their 90-day pilot program to educate local EMS providers and make them a bigger part of the stroke response at Shore and reduce stroke treatment time – with wildly successful results.

Education is Key
“We started by meeting with local EMS providers to reinforce their stroke symptom education, explain our stroke program and how their work can positively affect our stroke patient outcomes,” Schrevelius said. “We also emphasized how their concise and clear stroke reports that include the time of symptom onset help us know if we can administer the clot-busting drug tPA. TPA needs to be given within 4.5 hours from the first symptom onset for it to be effective. It can reverse the stroke and bring a patient back to their full normal, so it’s extremely important. If we have to call family or if the EMT is uncertain about these answers, it can delay the process. Education empowers them to be confident in their information gathering and reports so we can move faster.”

Richmond and her team also emphasized in education that Shore has a dedicated stroke hotline for EMTs to call when they’re coming in with a possible stroke patient. She gave each EMT a card with stroke symptoms to look for and the stroke hotline to keep handy. By calling the stroke hotline on the way to Shore, they can speak directly to a member of the stroke team and head right for the CT scanner, bypassing triage. Images provided from the CT allow the ER team to take the next steps in reversing the stroke or preventing further damage. 

Using education tools provided by the Joint Commission and Centers for Medicaid/Medicare Services, Rob and the team explained the stroke measures they use at Shore so EMS providers understand the steps involved in treating a stroke patient and their important role in the process. They held webinars and provided continuing education credits in partnership with Jefferson Health to help EMTs take their stroke knowledge to the next level. 

Tim Jackson is an EMT with Egg Harbor Township’s EMS providers, which also cover Somers Point. He couldn’t be happier with the results of this improved partnership. 

“Sherri and the team at Shore have been amazing. With all the support Shore has provided, we feel more confident in reporting what’s happening with the patient and whether we’re bringing them to the right hospital for the patient’s needs,” Jackson said. Based on the EMT crew’s findings, they will determine which level of care is most appropriate for the patient. 

Jackson appreciates how the team at Shore is involving them in the entire process, letting them know when their efforts result in a successful patient outcome. 

“Often we’ll transport a stroke patient, and we never know the outcome or if we helped save a life. Now Shore tells us whenever they can when we’ve helped save someone. Instead of feeling anxious, I am now actually excited when a stroke call comes in. I know many times we can make a difference in that patient’s life.” In fact, Jackson received Shore Medical Center’s new “I Saved a Brain” award thanks to his swift actions on a stroke case recently – another outcome of Shore’s successful pilot program. 

Flora Phillips is an EMT with Egg Harbor Township and Inspira who works with Jackson often. She’s been doing this work since 1978 and explained how it can be challenging to determine whether someone is having a stroke or not. But Shore supports the EMTs bringing them in as a possible stroke patient, no matter what.

“We had a dispatcher send us out for what sounded like a fall victim who needed help getting up, but when Tim and I arrived, we saw the patient’s face was drooping and knew this was someone having a stroke,” Flora said. “Other times it’s not as clear. Sometimes we have someone call saying they think they’re having a stroke, but it turns out their blood sugar is low. You have to ask a lot of questions – that’s how we get to the bottom of things. Even if you’re not positive, we have to bring them in. The CT scan will say definitively if they’re having a stroke or not. It’s great to be able to call and give the ER staff our report, because when we get there they’re waiting and ready for us to go straight to CT. That process has made a difference for a better patient outcome.”

Richmond and the stroke team are thrilled to be able to share the progress they’ve made in getting stroke patients treated faster with other Emergency Department clinicians at the upcoming conference. 

“As Emergency Department nurses and clinicians, we play a vital role in saving lives from stroke, but we recognize we’re not the only role. We need everyone to be on board with saving brains, and sometimes it takes more effort on our part to make sure we identify where the gaps might be and do something about it. We’re proud to help other hospitals learn from our efforts – in the end, it saves more brains and lives, and that’s why we’re in this field.”