It’s widely agreed that the sooner a stroke patient receives help, the better their chances of survival, and the better their recovery.
Graham McClelland has seen how strokes impact people in the most acute sense of the word. As a paramedic for the North East ambulance service, he dealt with stroke patients on the frontline.
Now, he’s trying to understand and improve the care people first receive when they’ve had a stroke.
McClelland is a researcher at Newcastle University, where his post-doctoral research is funded by the Stroke Association.
“The number of cases of stroke are huge and they’re going up,” he said in a webinar this week for the Stroke Association.
But, he says, there’s a need to improve the care stroke patients receive.
“Most strokes that happen in community, where the ambulance often first point of contact. We play a crucial role in getting stroke patients to the right care in the right time, which is really important, “ he says. “It’s a time-critical condition because the treatment window is so short compared to other conditions. Minutes count; it’s a time-critical emergency.”
Despite all the training and abilities paramedics have, McClelland says, there’s very little they can do to treat stroke patients in a meaningful way.
“Then best thing we can do is get you to the right care, to the right people, to specialist stroke centres, who can direct treatment. The best thing we can do is rapidly assess and identify stroke and get you to a hospital.”
“Once we get to the scene, there’s a certain time period of assessment, working out what’s going on, suspecting that you’re having a stroke and deciding what to do next,” he says. “Then, we’ve got to get you to a local hospital, but if that hospital doesn’t have an acute stroke unit, we’re better off taking you on further journey to a regional stroke unit.”
This, McClelland says, should all happen in an hour or less. But from his own research, McClelland found that the amount of time this process takes increased between 2011 and 2018. Travel time has gone up, which makes sense since stroke care is now more likely to be further away at a specialist unit. He pinpointed that the area that needs improving, where time can be cut down, is on scene with paramedics.
“How long we spend at the scene assessing and treating is the most worrying. Our care hasn’t changed in the last 20 years, so why are we spending longer at the scene, making decisions before getting you to the right care? This is a national problem, not just the north east.”
There isn’t enough detail on what could be sped up, McClelland says. It could be that paramedics need to carry our heart tracing in the ambulance, rather than on the scene, or there are assessments and treatments that could be shortened.
“We need to unpick this. I’m collecting data, talking to people, mapping out these timelines – and once we understand, hopefully we can design interventions to start driving times down,” he says.
McClelland is also looking at telehealth’s potential to improve frontline care for stroke patients, including using the smartphone to drive improvements in healthcare. He says technology could be game-changing for stroke care in the near future, and could help to identify stroke, and the type of stroke, quicker.
“For acute patients, there’s a gap in evidence,” he says. “How we use telemedicine to link up paramedics with receiving specialists and stoke consultants, the people making decisions when you get to hospital,” he says.
For example, technology could be used to reduce duplication of questions from the paramedics to the specialist, he says.
“Can we get [specialists] involved in care earlier, so that when we hit the hospital, things happen faster, they’ve got a plan in mind. Can we knock minutes off the decision-making?”
Another part of the process that hasn’t been looked at in depth, McClelland says, is ambulance call-takers.
“How call-takers trigger a stroke response is really not being looked at. We want to look at this; if we don’t trigger the appropriate response, everything gets delayed.”
