Retired Army Lt. Gen. George Crocker served 34 years active duty as a parachute infantry man including two combat tours in Vietnam. At age 72 in May 2015, he was still very active running 3.5 miles every other day, and regular checkups didn’t indicate any problems.
Then he suffered a stroke. Fortunately his wife, Vonda, found him ten minutes after the stroke occurred, called 911 and he was quickly transported to the Ozark Health Medical Center in Clinton where the Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) telemedicine program allowed him to quickly be assessed and treated with tissue plasminogen activator (tPA) before being transferred to University of Arkansas for Medical Sciences (UAMS) where an interventional radiologist used a catheter to remove two clots from his brain.
“Without a doubt, it saved my life,” Crocker said. “I’m sure grateful for the AR SAVES program or I would be a vegetable now, if I were alive.”
AR SAVES uses a high-speed video communications system that enables a stroke neurologist to evaluate patients at partner hospitals that lack such specialists. For the best results, patients must be evaluated and treated within the critical four and a half hour period after a stroke. Local ER doctors use standard stroke assessment protocols, and then all patients undergo a CT scan to determine the nature of the stroke prior to the initiation of treatment.
Crocker is one of about 3,000 people in Arkansas who have been evaluated by AR SAVES since it began in 2008, with more than 1,000 of those treated with tPA. The success in the program is credited with the stroke death rate in Arkansas recently going down from first to sixth in the country.
“AR SAVES has shown that the appropriate application of technology can, in fact, move the needle,” said UAMS Chancellor Dan Rahn, MD.
Where you live should not determine whether you live or die, said Curtis Lowery, Jr., MD, director of the UAMS Center for Distance Health.
“Before AR SAVES was established and expanded, the expertise of stroke neurologists was geographically limited to one or two places in Arkansas,” Lowery said. “Today that expertise can be accessed in 48 hospitals statewide keeping people from death and debilitating injury from stroke. Without the use of technology, there would be no chance of providing this quality service to a usually underserved population. Having grown up in rural Alabama, I know this to be the case in these areas.”
The idea is to create a virtual healthcare system that provides care to people wherever they are and whatever they need.
“The stroke program is an extension of this concept,” Lowery said. “It started with the ANGELS program to reduce premature births. After we created the telemedicine infrastructure, we were able to plug in other specialists. A virtual doctor visits the patient, and instructs the local practitioner to provide care that otherwise wouldn’t happen. The ultimate goal is improving the quality of care while also reducing costs. We now have telemedicine for hand trauma, pediatric orthopedics, psychiatry, burns, HIV, sickle cell disease, and spinal cord injury. We will deploy more things across the system as we move forward.”
UAMS does mock drills with the ER doctors and nurses to help them become more familiar with the AR SAVES procedures. Lowery said the ER staff love it because it helps them improve the quality of the service they deliver.
UAMS also works with people in jails who don’t have access to subspecialists.
Lowery said UAMS has one of the best telemedicine broadband systems in the country. UAMS received a $102-million grant to build the broadband system, which has brought a huge return on investment.
“This is due to the fact that patients before with strokes didn’t always die but were debilitated and spent many years to decades in long-term nursing facilities which are incredibly expensive,” Lowery said. “Preventing three or four of these patients from becoming debilitated justifies the existence of the program.”
AR SAVES Director Renee Joiner, BSN, said AR SAVES isn’t just a network of technology and high-speed broadband.
“It’s a network of clinicians, first responders and everyone understanding stroke and together defeating it case-by-case with awareness, expertise and quick action,” Joiner said. “This improvement in ranking is a victory we can share and will repeat.”
AR SAVES conducts many community-based education programs around the state each year. Recently “Strike Out Stroke” night was held at Dickey-Stephens Park in Little Rock.
“This program is built around education and highlighting symptoms of stroke and where to go for treatment,” Joiner said. “Education is a big part of what we do. In 2015, our outreach program reached more than 450,000 Arkansans.”
Joiner said that is important because many people before didn’t know how to recognize the symptoms of stroke, realize there was a treatment for stroke, and that getting a stroke victim to the hospital immediately can save lives.
“To get people to recognize the need to call 911 immediately, we use the FAST acronym that stands for Face, Arm, Speech and Time,” Joiner said. “Is one part of the face drooping? Can the person raise an arm? Can they speak? If they have any problems in those areas, get treatment as fast as you can.”
Another effort is to teach children to call 911. Many children are staying with their grandparents after school.
“When you are having a stroke, you don’t know what is happening,” she said. “You are confused. Teaching children this is an emergency and to call 911 is helping save lives.”
Joiner said being involved with AR SAVES is extremely rewarding.
“It is an amazing program,” Joiner said. “I am able to watch when we have patients in one of our rural area hospitals who can’t speak. In an hour and a half, they are back to near normal. It is incredible. We have surveyed, and our survivors tell us there are things worse than death and one is to be severely disabled.” AR SAVES is in the business of giving all Arkansans the ability to live a normal life after suffering from a stroke.