THE likely outcome for someone having a stroke in the Portland area will soon improve dramatically, when a new fast response service will be introduced into the district.

Currently when paramedics are called out to a suspected stroke, they typically bypass Portland District Health (PDH) entirely for either Warrnambool or Hamilton, which both have the Victorian Stroke Telemedicine (VST) service.

After a decade in operation and treating over 20,000 stroke patients in regional hospitals in Victoria and Tasmania, the Ambulance Victoria run service will be rolled out to PDH in the next month or two.

AV’s Director of Stroke Services Professor Chris Bladin, who has overseen the service since it started in 2013, said response time is the critical aspect of stroke response.

“The underlying principle for this is that time is brain, the quicker that we can treat those patients, the better the outcome will be,” Prof Bladin said.

If a suspected stroke patient comes into an emergency department that has the service, staff can call a 1300 number to reach an on-call stroke specialist who can advise medical staff, look at brain scans that have been done, consult with the patient and their family, and  work out the best treatment options.

“The quicker we can get that treatment happening, the better the chance that they will have less disability and they'll make a good recovery. “Some of those patients may in fact require further treatment they may need to be transported to Melbourne for very specialised care such as interventions, like putting a little catheter into a brain artery and removing the blood clot in that way, and we also coordinate that as well.”

Dr Andrew Walby, Director of Medical Services at PDH said once the service gets started, the hospital will be able to properly treat strokes.

“This service will allow patients that present at PDH urgent care to be placed in contact with a specialist who can visually assess the patient via a camera similar to that of a telehealth cart which many regional hospitals are equipped with,” he said.

“Historically if a patient presents with stroke-like symptoms at PDH, the patient has a CT scan and is then transported to another hospital for treatment. 

“This service allows for a much faster way to determine the type of stroke and the seriousness of the symptoms, and allows for medication to be administered on-site at PDH rather than losing time by having to move the patient to another medical facility.”

In the Glenelg shire 294 people reported stroke as a long term health condition at the last census, at nearly twice the rate per population than the state or country generally.

The shire also has a notably higher occurrence of diabetes and heart disease, both of which increase the risk of stroke.

Prior to VST being introduced to now 18 regional hospitals, Prof Bladin said most emergency emergency departments did not have a specialist, and staff would have to either do their best or send the patient to the city, costing them critical treatment time.

“We know that in regional areas, there's a 17% increase in the likelihood of stroke compared to metropolitan areas.

“The reasons for that of course, are complex, but it probably relates to the fact that in regional areas that access to people specialist with expertise in treating stroke and the risk factor prevention is, is less so one of the issues, of course, is that you have a stroke, you're at risk or higher risk of having a second stroke.

“One of the reasons we set up VSP was to make sure that it's broad stroke care is not just delivered in the metro area, but it's also delivered in regional areas.

“We like to say that whether you live five kilometres from a major metropolitan hospital or whether you live over 500 kilometres away in a regional centre. By using VSP, you're still going to have access to exactly the same stroke specialists.”

With only 26 specialists on their books who all chiefly work in major hospitals, Prof Bladin said getting specialists based out of regional is not feasible, but VSP offers good equivalent.

“When we set up at a regional hospital, we put in what we call a Tele Doc, it's basically a telemedicine cart, a computer on wheels that’s specifically built to survive the rough and tumble of living in an emergency department.

The machine has a high end camera on the top of it and other equipment, so the specialist can do a clinical examination and see exactly what's going on in very precise detail, then speak to the patient and answer questions.

“The patients and their families really feel like the consultant’s sitting at the foot of the bed, with their appearing on the screen and having a talk to them directly, and we know from the feedback that we get the patients really appreciate having that sort of tele presence.”

Fitting out the PDH emergency room and training staff to use the system is currently underway, after negotiations to get the service have gone on over recent years.

Over that time the work has been done to secure funding, make sure specialists will be available with the service extended (it will also now be available in Wodonga).

Prof Bladin said training staff to trust the service is very important.

“One of the things we like to say about tele medicine is that it needs to become second nature and not a second thought.

“In other words, it just becomes a very routine part of how you treat patients.

“It's got more and more popular as the years went by, and of course when COVID hit telemedicine just exploded and so everyone now knows about it, they feel comfortable about it - it's part of routine clinical practice.”