Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Monday, July 17, 2017

Ambulance ‘waiting times up to 90 minutes’ - Guildford to Frimley, UK

This almost certainly means that the 3-4.5 hour window for delivering tPA will be missed. So you will need to certainly stop the neuronal cascade of death that continues for the first week after your stroke event. What is their plan B to get you to 100% recovery? I would suggest diagnosis and delivery of tPA in the ambulance. That is doable:

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes



http://www.altonherald.com/article.cfm?id=120965&headline=Ambulance%20%E2%80%98waiting%20times%20up%20to%2090%20min%E2%80%99&sectionIs=news&searchyear=2017
SLOW ambulance response times averaging nearly 90 minutes rang alarm bells for objectors to NHS proposals to relocate stroke services from Guildford to Frimley.
Health Secretary Jeremy Hunt, the MP for South West Surrey. met with South East Coast Ambulance Service chief executive officer Daren Mochrie, NHS England national stroke director Professor Tony Rudd and NHS South East medical director James Thallon, last Friday.
The meeting at Waverley Borough Council’s office, heard ambulances were taking an average of almost 90 minutes to reach non-life threatening cases in Haslemere. It was attended by borough councillor Robert Knowle, the former Tory leader of Waverley, who said afterwards: “I am very grateful to Jeremy Hunt for arranging the meeting – but am very uneasy at the information given and the attitude of some attendees.
“It was reported average attendance time for an ambulance in Haslemere is one hour, 27 minutes, the worst in Guildford and Waverley, and on several occasions over two hours and in one case three hours, eight minutes.
“This is a cause for alarm, when, in heart or stroke cases, every second counts.
“It seems since the temporary closure of the stroke service at Royal Surrey County Hospital (RSCH) in January, 90 per cent of Guildford and Waverley patients have gone to Frimley Hyper Acute Stroke Unit (HASU), not the 60 per cent expected, and many have then been transferred back to the acute stroke unit (ASU) at RSCH.
“But Mr Thallon clearly said the RSCH ASU could not stay open as that makes Ashford hospital unviable.
“I am very concerned as that would mean all follow-up appointments would be at Frimley, which is remote with bad transport links, and not in the interest of Haslemere patients.
“If only 10 per cent of Guildford and Waverley patients are going to Ashford St Peters, the question surely is whether that is the right location for a HASU?
“Have Guildford and Waverley residents been failed by their clinical commissioning group?”
Mr Hunt’s office disputed Mr Knowles’ claim that Mr Thallon wanted to close the the Royal Surrey ASU, adding: “Professor Rudd, who also attended the meeting, was making the opposite point.”
Mr Hunt, who called the meeting as part of his dialogue to ensure no one’s stroke care is disadvantaged if the proposals are agreed, said: “There appear to be two separate issues.
“One is the changes to stroke care which involve the move to HASUs. These involve concentrating stroke care in a smaller number of HASUs where the care is 24/7 and likely to lead to better outcomes.
“The trade-off is between a marginally longer time to get to hospital, about 10 minutes more for Haslemere residents, but a more reliably high standard of care when you get there – for which consultants at the meeting said there was anecdotal evidence.
“Frimley and Ashford St Peters would be the HASUs serving South West Surrey constituents, with a pending decision as to whether the Royal Surrey should provide after-stroke care.
“My sense from the meeting was most people support this change but I asked for an independent assurance from Professor Tony Rudd, the most senior stroke consultant in the NHS, that he is happy with whatever final decision is taken in September.
“Where there is much greater concern is ambulance response times.
“The current target says ambulances must give an eight-minute response to the most urgent calls 75 per cent of the time. The trouble with a target like this is it can discriminate against more rural areas if an ambulance service prioritises bigger conurbations where they are more likely to get to patients quickly and therefore hit their target.
“For strokes, in Haslemere’s case, the average response time is 15 minutes, with 90 per cent of people seen in less than 26 minutes.
“This is an issue for many parts of the country which the NHS is actively considering with the ambulance response programme pilots and I hope we will find a way to resolve a sensible way forward soon. But whatever is decided nationally, Daren Mochrie is going to come back to me with some specific plans for Haslemere.
“But my take on this, is one that is relevant for the whole NHS and not just for Haslemere: The key measures should be outcome measures for patients rather than an arbitrary target.
“What matters is not how long an ambulance takes to respond to a call – but how long it takes from the moment a call is made to the moment a patient starts appropriate treatment.
“So I will be finding out from the NHS whether we collect this information for strokes and heart attacks and, if not, whether we can collect it. Then we need to decide what the best way to improve it is – for which setting the right targets for the ambulance service will be vital.”
The meeting was also attended by the borough council’s portfolio holder for health Jenny Else.
She said: “Given the large rural nature of the borough, residents are worried about ambulance response times, particularly in the south, stroke rehabilitation and the care of patients once they have been discharged.
“I have also responded to the Guildford and Waverly Clinical Commissioning Group consultation on stroke care in West Surrey.
“It is important the council and I use all the available forums and opportunities we have to ensure that the views and concerns of local residents are heard.”

No comments:

Post a Comment