North Alabama Neuro-Stroke Network

Cutting-edge care for the Stroke Belt

New telemedicine program allows neurologists in Huntsville to remotely examine patients at area hospitals

Time is not on your side during a stroke.

When a blood vessel inside the head is blocked by a clot or rupture, the brain is robbed of the oxygen and nutrients it needs to survive. For every minute treatment is delayed, nearly two million brain cells die.

Physicians and nurses on the front lines of stroke care can often prevent catastrophic neurological damage – when the diagnosis is made and treatment started quickly.

A new high-tech telemedicine program led by Huntsville Hospital aims to improve stroke care across the region by allowing neurologists in Huntsville to remotely examine stroke patients at outlying hospitals that may not have a neurologist available.

The North Alabama Neuro-Stroke Network launched in early April at Marshall Medical Center North in Guntersville and Marshall Medical Center South in Boaz.

Madison Hospital also recently joined the network. Other Huntsville Hospital Health System affiliates – Athens-Limestone Hospital, Decatur Morgan Hospital Decatur campus, Decatur Morgan Hospital Parkway campus, Helen Keller Hospital in Sheffield and Red Bay Hospital – will be added in the coming months.

Before the program went live, members of Huntsville Hospital’s Stroke Team traveled to Marshall Medical Center North and South to train emergency room physicians and nurses on best practices for neurological exams.

The training also included use of a portable, high-definition video camera system known as a telestroke cart that allows neurologists at Huntsville Hospital to see and talk with stroke patients in emergency rooms across North Alabama. The cart is wheeled to the patient’s bedside.

“It’s the same as having a neurologist walk into the exam room,” said Marshall Medical Centers CEO Gary Gore. “He just can’t touch the patient. This is a way to better coordinate our services to help stroke patients.”

Amit Arora, MD, is medical director of the North Alabama Neuro-Stroke Network. He said the program will bring timely, high-quality stroke care to every hospital in the network.

“There aren’t enough neurologists in the region to have one available at all hours at each hospital, so we’re using telemedicine,” said Dr. Arora. “We can examine stroke patients from Huntsville and help the local hospital make a timely decision. This gives the patient a chance to receive treatment faster.”

The goal is to remotely examine stroke patients and facilitate treatment within an hour of their arrival in the ER, he said.

Here’s how the program works:

When a stroke victim arrives at a North Alabama Neuro-Stroke Network hospital, emergency room staff will gather the person’s medical history, conduct an initial stroke assessment and order a CT brain scan. The scan provides detailed images of any potential blood clots, damage or bleeding within the brain.

If the hospital does not have a neurologist available, one of Huntsville Hospital’s six staff neurologists will examine the patient remotely – day or night – using the high-definition video camera system. The telestroke system allows neurologists in Huntsville to see and talk to the patient in real time, review their CT scan images and collaborate with the patient’s emergency room doctors and nurses on a treatment plan.

“We can use the camera to assess a stroke patient’s gaze, their strength, their speech, their ability to understand and communicate,” said Dr. Arora. “We’re also using it for people who have seizures and other neurologic symptoms that we may be able to help treat in their local emergency room.”

Following the remote assessment, neurologists in Huntsville decide whether to start the patient on the tissue plasminogen activator (tPA), a powerful clot-dissolving medication that can greatly increase a stroke patient’s chances of survival if administered within about three hours of the first symptoms.
Gore said Marshall Medical Center has historically transferred most stroke patients to Huntsville Hospital, which has the region’s only Neuro Intensive Care Unit and is also a Certified Primary Stroke Center by The Joint Commission.

By examining patients remotely, Huntsville Hospital neurologists can now make a more informed decision on whether to bring the person to Huntsville or let them receive care closer to home.

“The nursing education and protocols we’re putting into place with the North Alabama Neuro-Stroke Network are going to help patients tremendously,” said Dr. Arora. “We’re doing this because it’s the right thing to do.”
The North Alabama Neuro-Stroke Network is Huntsville Hospital Health System’s first venture into the growing field of telemedicine. It also represents the first time most health system campuses have joined together in a system-wide approach to treating patients.

“We have seven different medical staffs, seven different ERs and multiple hospital administrators all working together as a team,” said Dr. Arora. “That’s really unique.”

The program comes along at a critical time. Stroke is now the fifth-leading cause of death nationally and the leading cause of serious, long-term disability.
Alabamians are particularly at risk due to lifestyle factors such as fried foods and lack of exercise, said Dr. Arora. The state is part of the so-called Stroke Belt – a region of high stroke mortality stretching from Texas to the Carolinas.

“Alabama is really the buckle of the Stroke Belt,” said Arora.

Not surprisingly, Huntsville Hospital treats a large number of stroke patients – more than 1,000 in 2015. Click to learn more about our stroke program.