By ERWIN CHLANDA
A tele medicine system bringing revolutionary clot busting treatment to stroke victims in regional hospitals such as Alice Springs is being developed.
For “eligible” sufferers thrombolysis is very effective “and the evidence supports its use. It’s our only proven acute stroke therapy,” says Chris Levi, Professor in Neurology in the University of Newcastle.
And tele medicine can bring the expertise from hospitals with specialists on call 24/7 to hospitals which have well equipped emergency centres but no specialist stroke physicians.
The links enable specialists “to looking at the scans and the patients, helping the doctors to treat or not to treat with clot busting”.
For example, the Newcastle hospital now has a tele medicine link with the Taree hospital, 200 kms to the north.
Says Prof Levi in an interview with the Alice Springs News Online: “That’s probably what has to happen in Alice Springs. There is a top-notch group of stroke physicians in Adelaide. I imagine they would be very keen to help.
“At the other end of the tele medicine link are highly experienced people dealing with two or three cases a week. They would make sure the lesser-known facts and little traps are appreciated, and you don’t miss anything. That is absolutely the way to go, or at least, well worth exploring.
“It’s an area of expertise that requires a fair bit of training and experience, and ongoing education to maintain the skills to have a service that is fully functional.”
Prof Levi, a speaker at the stroke convention in Darwin today, says 10% to 15% of strokes should be getting the clot busting treatment “in an ideal world”.
Stroke treatment by tele medicine “is just beginning to happen in Australia,” says Prof Levi. “This is an absolute disgrace because we’ve had the technology available for a long time, yet there hasn’t been the investment and the training in treating particularly the hyper acute stuff.
“It’s not risk free. It carries a small risk of bleeding, even into the brain, which is disastrous if it occurs. You have to give the treatment to the right people in the right time frame.”
Prof Levi says the FAST recognition of stroke symptoms – Face, Arms, Speech and Time – is paramount. “If people come into the hospital within 90 minutes you can get a cure in every three of four people you treat.
“They may come in severely affected, maybe paralysed down one side, unable to speak, and you give them the treatment and the next day or the day after they effectively recover.”
While the number of cases may be low in Alice Springs, what would be the consequences for those people who need the clot busting treatment and are not getting it?
“It’s a probability game we’re talking about,” says Prof Levi, “but the probability is you will have a much greater chance of being left disabled, you won’t recover from your paralysis, your won’t recover your speech, your vision.
“Sometimes it leads to people having to go into residential care. This is now being recognised not just around Australia, but around the world.
“We’re often challenged by three things, the individual staff’s knowledge and capability, not having a tele medicine system or an ambulance system that is geared up, or the culture.
“Sometimes there are a few cultural barriers to new things. People don’t want to change. We used to not have any acute treatment. There wasn’t any urgency because you couldn’t do anything.
“Now we can – within four and a half hours – and that requires a paradigm shift for neurology, and that’s what many of us are now working on, change the culture and get the systems working.”
By ERWIN CHLANDA