To mark Action on Stroke Month, an Advanced Practitioner in Stroke writes about his experience, the importance of pre-hospital identification and communication of stroke, and the significance of the NHS Long Term Plan:
Where to start?
My name is Joe Dent. I’m a paramedic. I work at the Salford Royal Hospital near Manchester as an Advanced Practitioner for Stroke.
I have worked in the health service since 1991; 26 years spent in the Ambulance Service, the last 7 of those years as an Advanced Paramedic, and in June 2017 I joined Salford Royal in a new Advanced Practitioner role.
Throughout my time in the ambulance service I had always been struck by the way there appeared to be an inequality in the way stroke patients were treated and assessed. So, three years ago, when I was asked to become the lead for stroke for the College of Paramedics – something I hadn’t expected – I grasped the opportunity to have a say in paramedic stroke education and highlight aspects of pre-hospital care to the wider medical field. So, the journey began.
This January saw the publication of the NHS Long Term Plan, which included stroke as a new clinical priority, with a specific ambition on training and workforce. This was huge. An opportunity for the whole stroke community to step the work up another gear and work to meet the ambitions that will improve stroke care for patients across the whole pathway.
It was so important for stroke to be included in the Long Term Plan, and as a result, I was asked by the College of Paramedics to join relevant workstreams to help develop the workforce and an understanding as to how we could improve pre-hospital care for stroke.
From my previous experience, and after speaking to paramedics from across the country, I knew that education for pre-hospital clinicians was fractured, with what I would describe as an over-reliance on the FAST test.
While the FAST test is still seen as the best pre-hospital tool for clinicians, there are many more strokes that could be identified sooner if pre-hospital clinicians had more training and education. A workstream was formed to prioritise education and training, the use of technology, and the development of a training package and tools to support universities and ambulance trusts.
The phrase ‘time is brain’ is well known in the clinical world. It emphasises that nervous tissue is rapidly lost as stroke progresses and the sooner a person receives treatment for stroke, the less damage is likely to happen.
Through the training package in development we hope that more strokes are identified earlier, and that stroke will be given a higher priority, both in clinician training and in individual patient care.
For change to happen we need a unified and continuous approach to stroke care.
Great communication between pre-hospital staff and stroke centres helps to reduce the amount of time before a patient receives definitive treatment, but what will help even more is if more information is passed on, including details such as ‘patient demographics’.
Patient demographics provide information such as name, address, date of birth and NHS Number. This information can help clinicians to quickly look at patient history and medications, which can help in making decisions around whether treatment such as thrombolysis is appropriate for the patient.
Every little helps! I would ask that all my pre-hospital clinician colleagues pass as much information on as possible so that key decisions can be made earlier.
But saving time and acting quickly doesn’t stop there. Having dedicated and appropriately trained stroke staff is essential; a workforce that knows the pathway and knows who to go to, to get the help required so that patients get the treatment they need. Using guidelines such as the Royal College of Physicians’ National Clinical Guidelines for Stroke and the use of appropriate pathways, not only saves time but saves lives too.
Those of us that work in stroke can talk about patients that have received both good and sometimes not so good treatment. To achieve the best for our patients, it takes a full team approach working together to care for the patient, especially in stroke.
After 26 years in the ambulance service I thought I knew quite a bit about stroke. It turns out that I didn’t know as much as I thought I did. There is so much more to stroke care than the parts of the pathway I had experience in.
Although the first six months in my new role were tough, I’m so glad I continued with my journey as an advanced practitioner. There is still a lot of work to do with pre-hospital stroke assessment, but I work with some very committed and passionate people that are working together to get this right, for health professionals, but ultimately for our patients.