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Every Minute Matters A Stroke Story Published by the Independent Journal

A gathering of two teams took place on Tuesday night at Washington County Ambulance District Headquarters.  Those two teams were leaders and staff members from Washington County Memorial Hospital and Washington County Ambulance District.  The purpose of the gathering was simple: recognize two teams for coming together to achieve a common goal; saving the life of a fellow human being. 


On January 19th, around 9:30 in the morning, Mr. Carlyon was brought the Ambulance District Headquarters to be “checked out” at the request of his grandson, who just happens to be an EMT with WCAD.  The grandson, Joe, reported that his grandpa, Harold, just wasn’t acting right.  He was trying to get him to go to the hospital, for which grandpa refused.  But we was convinced to at least get “checked out” by the paramedics on duty. 


Mr. Carlyon was assessed by Critical Care Paramedic, Rita Koch-West and EMT, Laura Logsden.  The crew quickly determined that Mr. Carlyon was likely having a stroke.  Unfortunately, he was still refusing further care and treatment to a certified stroke center.  After some convincing, he agreed to be transported, but would only go to Washington County Memorial Hospital. 


The ambulance crew, knowing WCMH had recently started the process to become certified as a Level 3 Stroke Center, activated the “code stroke” process.  Since the patient was refusing to go out of the county, this was his best option for rapid care and to put the future stroke care plans WCAD and WCMH had created to practice. 


The WCAD crew arrived at WCMH at 9:45am and they were met by the waiting stroke team, led by Dr. Mullen.  The patient went directly to the CT scanner since the ambulance crew already completed the patients’ EKG, started an IV and drew the necessary blood work.  It was quickly confirmed that the patient was indeed suffering from an ischemic stroke, or a blood clot in a vessel of the brain that needed to be removed, quickly. 


The partnership between WCAD and WCMH ensures that in a “code stroke” situation, the ambulance crew will stay with the patient and ensure a ground Critical Care Transport Team is standing-by to immediately take the patient to a hospital in the St. Louis metro area as soon as the patient is stabilized and a clot busting medicine “tPA” can be initiated at WCMH.  The WCAD Critical Care Team can then maintain the tPA on the way to the city and ensure the patient receives whatever other treatments and medications they require on the way. 


The two teams had not yet had a change to test this plan in a “real life” situation.  But, since Mr. Carlyon was refusing to be transported out of county, this was the perfect opportunity to test the plan.  And the plan worked flawlessly. 


Everything with the care of an acute stroke patient is “time.”  Time is brain.  Every minute that a patient is suffering from an occluded vessel in the brain, blood flow and oxygen is being deprived from a certain area of the brain and tissue dies.  National goals are “door in, to tPA initiated, to transport out” in 90 minutes.  Mr. Carlyon was in the CT scanner, diagnosed with a stroke, blood pressure managed, tPA initiated and back in an ambulance headed to a Level I Stroke Center in the St. Louis metro area in 52 minutes. 


While in transit, Mr. Carlyon was cared for by the same Critical Care Paramedic that brought him into the hospital.  The partnership between WCMH and WCAD ensured the continuum of care.  Two organizations came together to form one team that “worked” for the patient.  That was the vision of the leadership team, it was put into practice and confirmed that it works.  Around the north end of the county, Mr. Carlyon’s condition changed.  His stroke symptoms were improving.  By DeSoto, his symptoms had completely resolved. 


Mr. Carlyon was discharged home two days later, symptom free and without deficits. 


This is the exact reason Washington County Memorial Hospital has gone after their Level 3 Stroke Center rating.  Time is brain.  WCMH is simply waiting for the approval from the state before they can say they are a stroke center, officially.


This is the exact reason why Washington County Ambulance District has a strong partnership with Washington County Memorial Hospital.  In a rural community, it takes diverse teams to come together to ensure the critically ill or injured are cared for appropriately. 


The gathering on Tuesday recognized just that.  It recognized skilled clinicians for their hard work.  It also recognized a vision of a collaboration of efforts to ensure positive outcomes for the patients we collectively serve.