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Great Health Divide | Kentucky’s playbook for timely stroke care

Minutes matter. Yet many rural Kentuckians face an uphill battle to get the care they need, and quickly.
Updated: May. 24, 2021 at 2:37 PM EDT
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Editor’s Note: This story is another installment in WKYT’s year-long effort to examine how health disparities in the Appalachian region are being addressed, as part of Gray Television’s ‘Bridging the Great Health Divide: Mississippi Delta and Appalachia,’ an initiative exploring why disparities exist in those regions and focusing on long-term and sustainable solutions.

LEXINGTON, Ky. (WKYT) - If a person is showing signs of a stroke, doctors say every tick of the clock can mean more lost brain function in the future.

It is a prevalent problem. The CDC says someone in the U.S. has a stroke every 40 seconds, and someone dies from a stroke every four minutes.

Minutes matter. Yet many rural Kentuckians face an uphill battle to get the care they need, and quickly.

In Kentucky, relatively recent policy changes and new technology are helping bridge the great health divide for stroke patients, but experts say there is still work to be done.

[MORE: Bridging the Great Health Divide]

As a long-time paramedic, Chuck O’Neal knows well the tough decisions that emergency medical services have to make daily for stroke patients. Now it is part of his job to help make it easier to know what to do.

“Paramedics are used to making these life-saving decisions,” said O’Neal, who says he is in his 21st year as a paramedic and is also deputy executive director of administration for the Kentucky Board of Emergency Medical Services, or KBEMS. “They’re trained well. We continue to try to put training recommendations and tools out there for them so they can make quality decisions that are going to positively impact these patients’ lives.”

KBEMS, which licenses, regulates and provides resources to EMS across the state, has implemented a statewide stroke triage policy - a playbook of sorts to help assess stroke patients and figure out where to take them, because every second makes a difference.

“For major ischemic strokes, meaning blockages of blood vessels in the brain, patients can lose as many as 1.8 million neurons per minute,” said Dr. Justin Fraser, director of cerebrovascular surgery and surgical director of the University of Kentucky Comprehensive Stroke Center. “It moves very quickly.”

The state’s only comprehensive stroke centers at this time are in Lexington and Louisville, so right now, if a procedure like a thrombectomy is needed to clear the blockage it has to be done there.

[InvestigateTV: In Appalachia and the Mississippi Delta, millions face long drives to stroke care]

A new classification - thrombectomy-capable stroke center - has also been approved, although Kentucky does not currently have any hospitals at that classification, O’Neal said. Having an “in-between” classification where those procedures could be done could be helpful for rural stroke patients, he explained.

Hospital certifications vary for what kind of stroke care they are able to provide.
Hospital certifications vary for what kind of stroke care they are able to provide.(The Joint Commission)

In the meantime, it is why protocols like the ones KBEMS implemented are so important to make sure patients are taken to the right place depending on what they need - whether it is a nearby hospital, or the comprehensive stroke centers potentially farther away.

“We’ve been really trying to make inroads to ensure that every Kentuckian has access to the best and optimal stroke care, and there are a number of ways to do that,” Dr. Fraser said.

Dr. Fraser also chairs the KBEMS Cardiac and Stroke Subcommittee, which is trying to address those issues.

In Kentucky, 11 percent of people live more than a 45-minute drive from a certified stroke center, according to analysis by Kaiser Health News; 52 percent of people live within 45 minutes of a hospital with the most advanced levels of stroke certification, KHN found.

[MORE: WKYT Investigates]

Dr. Fraser says his subcommittee has been collecting and analyzing data from EMS transports, hoping to find ways to improve. They are already using technology to help doctors at more advanced stroke centers communicate with staff at other hospitals the moment a stroke patient goes through that hospital’s doors.

As of this writing, eight hospitals in Appalachian Kentucky are certified to give tPA, a clot-busting drug, which is a common treatment for strokes but has to be given through an I.V. within 4.5 hours of the onset of symptoms.

That makes community members as much a part of the stroke team as the doctors, Dr. Fraser said, highlighting the importance of early recognition of stroke symptoms that can be remembered by the mnemonic ‘BE FAST’:

  • B - Balance (off)
  • E - Eyes (unable to focus)
  • F - Face (drooping)
  • A - Arm (weakness)
  • S - Speech (difficulty)
  • T - TIME TO CALL 911.
One of KBEMS' protocols for assessing stroke patients.
One of KBEMS' protocols for assessing stroke patients.(Provided)

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