SC Stroke System of Care Joy Brooks, MHA Director, Heart Disease and Stroke Prevention SC DHEC Learning Objectives Describe the burden of stroke in SC Outline the process for the SC Stroke System of Care State Plan development Examine the EMS protocols for stroke care in SC Describe stroke center recognition, the stroke system of care today, and stroke legislation which impacts the system moving forward STROKE EPIDEMIOLOGY National Stroke Death Rate, 2006-2008 Adults Age 35 and Older (per 100,000 Crude Rates - ICD10) South Carolina 1
SC Stroke Burden SC has consistently had one of the highest stroke mortality rates in the nation. Our state is in the stroke belt and has had the highest or second highest mortality rate since 1983. Prior to 2005, for three decades, SC was ranked either first or second in stroke mortality then moved to fifth, and remained at that same ranking in 2007. African Americans in SC are 61% more likely to die from stroke than the white population. SC Stroke Burden In 2010, 15,025 people were treated for stroke in S.C. hospitals, for a total cost of $560,929,600. In 2008, 20% of stroke deaths in SC were among persons under the age of 65. This compares to 14.7% of stroke deaths nationally in 2007 under the age of 65. SC Stroke System of Care Voluntary Stroke Systems Task Force established October 2007 Legislation introduced to establish Stroke Systems of Care Study Committee January 2009 Became law May 2009 Managed through SC DHEC, supported in partnership with AHA/ASA no fiscal resources allocated 2
SC Stroke System of Care 18 members appointed by SC DHEC Board Dr. Robert Adams, Chair. This committee was comprised of expert members representing organizations and health care disciplines involved in stroke treatment and prevention. The full committee met a total of six times over 14 months to identify barriers, gaps, and recommendations to improve the stroke system of care in SC. Four dedicated subcommittees addressed public awareness, education, prevention, and disparities; urgent response; hospital-based stroke treatment; and rehabilitation. Comprehensive plan for a statewide stroke system of care submitted to the Governor and General Assembly, December 2010. SC Stroke System of Care Conceptual Model 3
SC Primary Stroke Centers 2005 2008 2009 2010 2011 Spartanburg Regional (Spartanburg, AnMed Health Medical Center (Anderson, East Cooper Medical Center (Mount Pleasant, Greenville Memorial Medical Campus (Greenville, MUSC Medical Center - University Hospital Roper Hospital Bon Secours - St. Francis Hospital Piedmont Medical Center (Rock Hill, Coastal Carolina Medical Center, Inc. (Hardeeville, Mary Black Memorial Hospital (Spartanburg, Palmetto Health Richland (Columbia, Trident Medical Center LLC * as of June 8, 2011 Stroke Telemedicine- REACH Stroke Bill received a hearing before the Senate Medical Affairs subcommittee on March 16 th, 2011 and passed favorably to the full committee on March 17 th, 2011. The bill was passed favorably from the full committee for second reading in the House. The Bill, now named the Stroke System of Care Act of 2011 returned to the House on April 13, 2011 following amendments. Stroke Bill The Stroke Prevention Act of 2011 was introducedin thesenate on February 17, 2011. The bill was referred to Senate Medical Affairs Committee. Stroke Systems of Care Study Committee Report Press Conference at the State House was held on February 24, 2011 with great support and significant media coverage. 4
Stroke Bill On June 1, the South Carolina Legislature unanimously passed, and Governor Haley subsequently vetoed, the Stroke System of Care Act of 2011, which is based on the recommendations of the legislatively mandated Stroke Systems of Care Study Committee which was comprised of 18 experts representing organizations involved in stroke treatment and prevention. Even though the Governor did veto this legislation, support in the South Carolina Legislature was strong. On June 21 st they successfully overrode Governor Haley s veto by a vote of 42 to 1 in the Senate and a 106 to 1 vote in the House. The Stroke System of Care Act of 2011 became law on June 21, 2011 which will, upon appropriation of funding, identify Primary Stroke Centers and hospitals that are acute stroke capable, establish pre-hospital protocols for stroke assessment and treatment and transport by EMS, and establish a Stroke Registry and Stroke Advisory Council. Priority Recommendations: Stroke System of Care Act of 2011 Identifies Primary Stroke Centers and hospitals that are acute stroke capable, oversight by DHEC. Requires EMS providers to transport stroke patients to the nearest appropriate stroke capable facility. Allows hospitals that do not have primary stroke center certification, but use telemedicine, to be integrated into a statewide stroke system of care to allow rapid diagnosis and treatment for patients in rural areas. Establishes pre-hospital protocols related to the assessment, treatment, and transport of stroke patients by licensed EMS. Establishes a Stroke System of Care Advisory Council and a Stroke Registry Task Force to analyze data generated by a statewide stroke registry database and identify interventions to improve stroke care. SC Emergency Neurologic Evaluation (SCENE) Tool FAST NEUROLOGIC EXAM (Check if abnormal) YES NO Facial Droop (Smile, show teeth) Arm Drift (Extend both arms, eyes closed) Speech ( You can t teach an old dog new tricks ) STROKE ALERT CRITERIA YES NO Time of onset < 8 hours Positive FAST (=1 or more from FAST NEURO EXAM) Blood glucose > 60 mg/dl (if fingerstick possible) If YES to all STROKE ALERT CRITERIA, transport to nearest stroke hospital and call Stroke Alert. Minimize scene time and transport patient urgently. Management Reminders: Do not treat hypertension Do not allow aspiration (keep NPO) Provide oxygen (if O2 sat < 94%) Do not administer glucose (unless glucose < 60 mg / dl) 5
HDSP Future Direction Focus on the ABCS, as directed by CDC: Aspirin, Blood Pressure, Cholesterol, Smoking Cessation Check us out at www.scdhec.gov/hdsp Contact Info Joy F. Brooks, MHA Director Heart Disease & Stroke Prevention Division SC DHEC - Bureau of Community Health & Chronic Disease Prevention 1800 St. Julian Place Columbia, SC 29204 803-545-4497 BrooksJF@dhec.sc.gov 6