At 88, doctor pursues a long-ignored treatment for strokes, heart attacks

Re:At 88, doctor pursues a long-ignored treatment for stroke... by thomasfedb on Sunday April 08, 2018 @10:35AM (#16786252)

I'm a volunteer ambulance officer in Western Australia. We certainly don't carry thrombolytic agents. What we do have though is a protocol for getting stroke patients (with good predicted outcomes) into a helicopter or fixed-wing aircraft ASAP so they can get to a hospital with a thrombectomy (clot retrieval) service. If called promptly, then there shouldn't be many patients that we can't get to the right care within a suitable timeframe.

[ Parent | on HN ]

Re:At 88, doctor pursues a long-ignored treatment for stroke... by autokad on Sunday April 08, 2018 @12:17PM (#16786791)

> "If called promptly, then there shouldn't be many patients that we can't get to the right care within a suitable timeframe."

I worked with stroke centers, doctors, etc in building stroke access systems, and that doesn't fly with reality.

Number 1, is that its hard for patients to recognize they are having a stroke. so "If called promptly" is a bit of unrealistic idealism.

Although they say 4 hours, tPA administered after 1 hour has lost most of its benefit, and places that can do thrombectomy 24/7 (in US dedicated stroke centers) is not numerous. You are losing a lot of that hour just for time for the helicopter to warm up, find a spot, and land + your ambulance time getting to /stabilizing the patient.

I'm sure the patients on your beat had suitable access, but that's a bit of selectivity bias no? In the US, although the majority of the population is within the golden hour, there are still a ton of population that does not have access to a stroke center. I find it extremely hard to believe that this is not the case in Australia - where I have heard stories of people getting a finger cut off and having to drive 3 hours to the nearest hospital.

[ Parent | on HN ]

Re:At 88, doctor pursues a long-ignored treatment for stroke... by thisrod on Sunday April 08, 2018 @11:03PM (#16790002)

Remember that Australia is ridiculously urbanised. About 80% of Western Australians live in Perth. Contrasted to the US, the most remote Australians must be a lot further from a referral hospital, but the median Australian might actually be closer.

[ Parent | on HN ]

Re:At 88, doctor pursues a long-ignored treatment for stroke... by thisrod on Sunday April 08, 2018 @10:55PM (#16789976)

Is there any possibility that Australia would allow volunteers to administer drugs this dangerous, no matter how effective those drugs were? Not to be rude—I volunteer for an emergency service too.

[ Parent | on HN ]

Re:At 88, doctor pursues a long-ignored treatment for stroke... by thomasfedb on Sunday April 15, 2018 @10:15AM (#16842691)

Asprin, paracetamol, glucose, adrenaline (epinephrine) auto-injectors, salbutamol, glyceryl trinitrate (GTN), methoxyflurane, ondansetron, cophenylcaine (lidocaine + phenylephrine) - that's our volunteer drugs in WA. We're hoping that eventually ketamine will be added. I don't see tPA ever being on that list.

[ Parent | on HN ]

Re:At 88, doctor pursues a long-ignored treatment for stroke... by robbiep on Monday April 09, 2018 @12:23AM (#16790348)

That's interesting. Where I trained (central coast, Hunter New England) they do but only for STEMIs, administering'should' occur after a scan in the Ed otherwise

[ Parent | on HN ]