San Diego County Doctors Propose Regional Stroke System, Concerns Mount Over Implementation
A group of San Diego County doctors have called for the county health department to establish a regional stroke care system similar to the county's six-hospital trauma network, the San Diego Union-Tribune reports.
To implement the system, paramedics would undergo training to identify stroke symptoms and transport patients only to hospitals certified as stroke treatment centers where stroke teams would order CT scans and lab tests for glucose levels and blood clots to determine whether t-PA, a treatment that can dissolve clots in arteries in the brain, should be administered.
Nancy Bowen, the county's public health officer, said that at County Supervisor Pam Slater-Price's recommendation a county task force "will identify the benefits and problems with changes to the system of care."
James Dunford, medical director for San Diego's paramedic service; Tom Chippendale of Scripps Memorial Hospital in Encinitas; and Jack Schim, a neurologist at Tri-City Medical Center in Oceanside, are among those who support the regional stroke system.
Some hospitals have voiced concern that they would lose patients if they do not become stroke centers, the Union-Tribune reports.
Richard Stennes, who has worked at Paradise Valley Hospital in National City and is a former president of the American College of Emergency Physicians, and some colleagues estimate that for each patient who had a stroke, paramedics would divert as many as 10 patients who did not have a stroke or who had one that occurred too long ago for treatment.
In addition, some doctors avoid using t-PA because it can cause bleeding in the brain if administered to some patients. ACEP has said its members should not be required to make judgments on stroke care without backup from neurologists or neuroradiologists (Clark , San Diego Union-Tribune, 9/21). T-PA must be administered within three hours of a stroke patient's first symptoms (Clark , San Diego Union-Tribune, 9/21).
According to the Union-Tribune, how the system would be configured, whether to require stroke treatment centers to document a high-volume of stroke patients and reimbursement for stroke treatment also are issues of concern (Clark , San Diego Union-Tribune, 9/21).