REACH
Program Brings
MCG Expertise to Rural Stroke Patients
REACH=Remote Evaluation of Acute IsCHemic Stroke
When 46-year-old Curtis Daniel went to bed, it had been a day like any other... nothing special or out of the ordinary.
That is, until he awoke at 3:15 a.m., violently coughing and struggling to breathe against the invisible noose around his neck. Mr. Daniel made his way to the bathroom, and his wife, Amanda, rolled over and went back to sleep.
But the coughing grew more violent, again waking Mrs. Daniel. He mumbled that he was strangling, but coughed up whatever was in his throat, so Mrs. Daniel again rolled over. “Sometimes, he coughs at night,” she explained. “I really didn’t know what was going on.”
As Mrs. Daniel once again dozed off, Mr. Daniel slipped into a pair of shorts and went out to the front porch for a bit of fresh air. About 10 minutes later, Mrs. Daniel found him, glassy-eyed with the left side of his face drawn and his left hand hanging limp between his legs.
She asked if he could move his left arm. “He shrugged his shoulder and mumbled words I couldn’t understand,” Mrs. Daniel said. “I asked again. This time, he gave me a look that said, ‘I already did what you asked. Why are you asking again?’ That’s when I tried to get him on his feet, but his left leg collapsed.”
Mrs. Daniel called for an ambulance. “I thought it might be a stroke,” she said. “I have uncles on both sides of my family who have had strokes, and my mother is a nurse who works with stroke rehab patients, so I kind of know the signs.”
Emergency medical technicians confirmed her
suspicion when they reached the Daniels’ home minutes later.
Mr. Daniel’s blood pressure soared to 208/100 during the 12-mile drive from their Harrison, Ga., home to Washington County Regional Medical Center in Sandersville, Ga. By the time they arrived, Dr. David Hess, MCG Health System’s chief of neurology, was consulting via a secure webcam feed. The REACH program was ready to save another life.
REACH (Remote Evaluation of Acute IsCHemic Stroke) was launched in early 2003 to enable MCG neurologists to consult on rural stroke cases 24/7. The neurologists help medical professionals administer tPA, a clot-busting drug that can mitigate the debilitating effects of a stroke if given within three hours. MCG physicians can actually see patients via a secure feed, review the CT scan online, evaluate physical signs and symptoms, download information regarding medical history from the participating hospital and send back instructions.
“Mr. Daniel had severe weakness of his left face, arm and leg and appeared to have suffered a large stroke in the distribution of his right middle cerebral artery,” said Dr. Hess. “I rated him as having 15 points on the National Institute of Health Stroke Score. This corresponds to a fairly severe stroke. Washington County staff did an excellent job of presenting him to me and getting the CT scan done quickly. I felt he was a good candidate for tPA and we decided to treat him. We also ordered the helicopter to fly out to Washington County right away, as patients with strokes this large can deteriorate quickly.”
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Timing, he stressed, is everything. “For stroke patients, a mere three-hour window exists during which we can administer tPA. Dealing with this time constraint has been a struggle for many rural hospitals. That’s what makes REACH such an important disability-prevention program.” Once tPA was administered, Mr. Daniel was airlifted to MCG Medical Center, where Dr. Hess monitored his progress. The very next day, less than 24 hours after suffering a stroke, Mr. Daniel was walking by himself. Less than a week into his hospitalization, Mr. Daniel’s speech and mobility were functional. “I expect him to make a full recovery,” said Dr. Hess, adding with a smile, “as long as he follows doctors’ advice.” Mrs. Daniel credits the REACH program with saving her husband’s life. “It was three hours between the time that Curtis woke up and we arrived at MCG via helicopter,” she said. “Those were the longest three hours of our lives. We are so grateful for the REACH program. I don’t believe they would have been able to save him without it.” REACH is working with several rural hospitals to extend the program into South Carolina. Health organizations from North Carolina, Florida and Montana also have expressed interest following a REACH presentation at an American Heart Association meeting, so Dr. Hess anticipates continued expansion. -- Deborah Humphrey |
Georgia REACH PartnersWashington County Regional Medical Center McDuffie Regional Hospital Emanuel County Hospital Jenkins County Hospital Wills Memorial Hospital Morgan Memorial Hospital Jefferson County Hospital Elbert County Hospital Ty Cobb Hospital
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"We are so grateful for the
REACH program. I don't believe
they would have been able to save him
without it."
--Amanda Daniel