Shift in cardiac, stroke care takes effect around state

A new state system that puts added emphasis on the need for speed and cutting-edge drugs and surgery includes the designation of two local hospitals as high-level treatment centers.

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WALLA WALLA -- How much time do you have?

If you're having a heart attack or stroke, the answer depends on what you do in the next few hours.

If you recognize what's happening and get prompt medical care, you could have many years of good health ahead of you. If not, you could be dead or permanently disabled before the day is done.

"Time is muscle, time is brain," in the words of Linda Givens, a registered nurse and director of critical care services at Walla Walla General Hospital.

The hospital, along with Providence St. Mary Medical Center, has been designated a Level II stroke and cardiac care center as part of a state law enacted last year.

Hospital officials say the designation -- which means a facility can treat most stroke patients -- doesn't mean a seismic shift in care at either facility because both already use widely accepted best practices in stroke and cardiac care. But the state's new system does mean patients can know what to expect when they set foot in a particular facility.

"Standards have been in place, naturally, but they haven't necessarily been organized in a state system or even a county system," said Susan Leathers, a registered nurse and cardiac program coordinator at St. Mary.

"It really does verify the great care that is being given." added Margaret Evensen, also a registered nurse and St. Mary's stroke program coordinator.

"The beauty of it is ... you get the practices offered to people everywhere in the state," she said.

What that means for a patient at WWGH or St. Mary is a standardized, rapid assessment in the field, round-the-clock access to specialists after arrival at the hospital and the best drug and surgical interventions, delivered within 120 minutes of the onset of symptoms.

The need for speed in cardiac and stroke care mirrors that of trauma care, and in some ways may be even more urgent. For every minute the clocks ticks by, damage piles up and the chance of death or major, long-term disability increases.

"If they wait too long there is a lot less that can happen for them for the good. If they get (to a hospital) quickly, there is so much that can happen," Givens, of WWGH, said.

In the case of the most common form of strokes, for example, a drug that breaks up blood clots can provide almost miraculous results -- as in a patient leaving the hospital on foot instead of embarking on a life spent in a wheelchair -- if administered up to 41/2 hours from the beginning of symptoms. The sooner, the better, as you might imagine.

But the drug, tissue plasminogen activator, is only used after a less-common form of stroke has been ruled out, which puts a premium on a seamless system for triage, transport and assessment, let alone administration of the drug and other care.

Leathers compared the push to enact the state law to the grassroots efforts in decades past to make trauma care the systematic practice it is today. In this case, an aging population was the key to the legislation.

"We are really facing the reality of the Baby Boom generation in health care," Leathers said. "A huge number of people are living longer and having these chronic diseases.

"They want the same quality of living down the road."

Alasdair Stewart can be reached at alasdairstewart@wwub.com or 526-8311.



On the web

State Emergency Cardiac and Stroke System: ubne.ws/miyzxw

Wikipedia page on tissue plasminogen activator (tPA): ubne.ws/kxdm9D

An ounce of prevention ...

The samurai Yamamoto Tsunetomo wrote that meditation on inevitable death should be performed daily. That might be too often for most people, but it can be a valuable exercise.

Take a moment to consider the most common causes of death in Washington state: heart attack, cancer, stroke, chronic lung disease, unintentional injuries, Alzheimer's disease, diabetes, pneumonia/flu, suicide and liver disease.

Only heart attack and stroke have the combination of being outcomes of chronic diseases that also require the most immediate care possible. There is simply no time to spare.

According to figures provided by Providence St. Mary Medical Center, heart attacks and strokes are the No. 1 and 3 killers, respectively, of residents in Walla Walla County.

Risk factors for both are similar: Older people are more susceptible, and rates decrease as education and income increase.

Factors over which a person might be seen as having more control include hypertension, high cholesterol, diabetes, smoking, insufficient physical activity and being overweight or obese.

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