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MUSC Annual Report 2011-2012

REACH Network - Driving Force Behind Stroke Prevention, Rehabilitation Efforts

The year was 1924.

Calvin Coolidge was president. In Russia, Vladimir Lenin died, signaling the rise to power of Josef Stalin.  Two U.S. Army Air Service planes had the distinction of being the first to fly around the world on a trip that took 175 days. The IBM company was founded, and one of the more enduring, if not the most tasty, icons of modern life – frozen food – was in the early stages of commercial production by a man named Clarence Birdseye.

It was in April of 1924 that a popular magazine called Radio News tepidly predicted the future of health care: THE RADIO DOCTOR – Maybe!  The cover's illustration resembled a Norman Rockwell painting: A boy sitting on his bed with his tongue sticking out, facing a contraption the size of a small bookcase filled with all sorts of gadgets, dials and graphs. One of the gadgets protruding from the machine was a stethoscope that the boy obediently held to his chest. In the middle of this contrivance was a video monitor, and in the monitor was a kindly doctor in some remote location, looking down the boy's throat.

In April 1924, it would still be another two years before the first images are transmitted over a television system. Talk about visionary.

Fast forward to today.

At 14 hospitals networked with the Medical University of South Carolina, emergency department staffs can communicate with MUSC stroke experts when a suspected stroke victim is brought in. With the use of a computerized cart with audio-visual capability and a secure Internet connection, hospital staff and the patient's family can see and talk to an MUSC stroke expert, who also can study the patient's CT scan, and recommend a course of action.

Since May 2008, this process has occurred more than 2,000 times in hospital emergency departments across South Carolina. Today, the REACH network (an acronym for Remote Evaluation of Acute isCHemic stroke) connects 15 hospitals from the Lowcountry to the Pee Dee to the Upstate to MUSC's stroke experts 24 hours a day, seven days a week, every day of the year.

"We can put a stroke expert in their emergency room in 10 minutes or less," says Robert J. Adams, M.S., M.D., director of MUSC's Stroke Center and the REACH program.  The time factor is crucial for any recovery to occur. Stroke is a leading cause of death and the No. 1 cause of disability nationwide. Although no region of the country is immune to stroke, people in South Carolina – in the middle of an 11-state region known as the stroke belt – are particularly susceptible to the disease, with death rates twice as high as the national average. The chances of someone under 65 having a stroke are 40 percent higher in South Carolina than the national average.

Personal interaction is one of the primary components of a strong patient-physician relationship, of course, and Adams believes REACH can meet that need even when some distance is involved. "We make a bond with the patient and the family as well as local emergency department staff, Adams says. "I would say the relationship that we make with REACH is more with the family because the patient is overwhelmed with what's happening. The family has an opportunity to actually see us with the way our picture is projected to them. And we can talk to them and explain what we're going to do."

Stroke can be treated with Alteplase, a clot-busting drug also known as tPA, but it must be administered within three hours of the stroke according to FDA guidelines. The number of hospitals in the network also works to the patient's advantage, as 76 percent of South Carolinians are within a one-hour drive of a REACH hospital or a Joint Commission primary stroke center.  Before the network existed, only 38 percent were within 60 minutes of a stroke expert.

Still, with all the advantages the network provides, the concept had to be sold to the other hospitals, which meant meetings, training sessions, and, of course, equipment purchases. "It's a network. A network is a living thing, so we had to build this from the ground up, go to hospitals and get them to understand why this was the most efficient way for them to meet their needs for stroke," Adams says. "The existing situation was they would call us and transfer the patient, which would take too long. Everybody I think is gaining in appreciation of the fact that there is window for the treatment of stroke. This window of treatment for stroke is something that everyone knows now and quite honestly, more and more of the public is expecting to be treated within that window."

As a by-product of membership in the REACH network, hospitals enjoy enhanced status in their respective communities and tend to promote the MUSC connection, Adams believes.

Adams, holder of an endowed chair in stroke at MUSC, came from the Medical College of Georgia, where he also held a distinguished faculty position and has held prominent leadership positions in national stroke organizations. Through his work and the REACH network, Charleston is now one of the preeminent stroke treatment and research hubs on the East Coast, along with Miami, Jacksonville, Fla. and Washington, D.C.

In addition to MUSC's status as a stroke treatment hub, however, Adams and his staff have helped to lay the foundation for a comprehensive research and rehabilitation center, collaborating with other programs across the campus. Research activities involve sickle cell anemia and stroke disparities. In the rehabilitation area, the Stroke Center is collaborating with the Center for Rehabilitation Research in Neurological Conditions, co-directed by Steve Kautz, Ph.D., and Jim Krause, Ph.D.

"The Harborview Stroke Center is a research incubator," Adams says. "It's a large area that contains a number of programs and a staff that can help anyone get a project off the ground quickly. Someone can use up all their resources just doing paperwork. We can help them with a project that makes sense and is doable."

There is another field into which the Stroke Center is expanding – spinoff biomedical production. Adams has established a company called South Carolina Science Solutions, LLC, using technology to solve medical problems. "The device I'm developing, in conjunction with the MUSC Foundation for Research Development, cannot be disclosed to the public yet, but we think it will be a success and we look forward to bringing it to market in South Carolina," Adams says.

Ideally, perhaps the best way to deal with the stroke problem is to prevent them from ever happening, or at least significantly reducing the occurrences. REACH is working toward that end as well, collaborating with the South Carolina Area Health Education Consortium (AHEC) to provide stroke education and awareness programs across the state. "We're overlaying the REACH map and the AHEC map and looking for ways to help each other carry out our missions," Adams says. Additionally, REACH is working with the College of Nursing through a grant provided by the South Carolina Center for Translational Research (SCTR) to raise community awareness on the connection between human behavior and stroke risk factors.

In just a few years, Adams and his staff have assembled a comprehensive stroke center more advanced than any other in South Carolina and one of the few elite centers on the East Coast, put together a network of hospitals to help treat residents virtually anywhere in the state, collaborated with other MUSC departments to help rehabilitate stroke victims, and established outreach programs to help prevent future strokes. In 1924, magazines touting such advancements would have been classified science fiction. Today it's science fact.


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