The problem is that first responders can’t necessarily tell how severe a stroke is just by looking at someone. So, they rely on an evaluation of the patient’s symptoms to make the best choice.
The gravity of these decisions weighs on Jamey Beaty, a paramedic in Fentress County, who responded to Lottie Crouch’s home.
“When you’re in the back of a truck and all alone and you have a patient actively dying on you, the only thing you can think about is: How can I keep this patient alive until I can get them somewhere?” Beaty said. “That’s all that crosses your mind.”
Anytime Beaty gets a call about a stroke, his first response is to look at the sky.
Since the local hospital closed, an air ambulance is how he quickly gets people to treatment. The day Lottie Crouch had her stroke, luckily the Tennessee sky was clear blue. Crouch was taken nearly 100 miles to a hospital in Knoxville with advanced stroke services.
Long journeys to advanced care
Over the past two decades, two main treatments have advanced care for strokes caused by a blockage — the most common type of stroke in America. The first is a medication delivered through an IV to break up clots in patients’ blood vessels. The medicine has to be given within 4½ hours of when symptoms start. The second is a procedure using a catheter to physically remove the clot from a patient’s vessels. This treatment can be done up to 24 hours after symptoms start but is generally used only for severe strokes.
Across the country, hospitals are certified by tiers, largely based on their ability to regularly provide these treatments. Some hospitals have no certification. Among stroke-certified hospitals, the first level is acute stroke-ready hospitals, which can assess stroke patients, keep them stable and provide clot-busting medications. At the other end of the spectrum are comprehensive stroke centers, which have specialized teams of neurologists and neurosurgeons. In addition to giving the clot-busting drugs, these centers can physically remove clots.
The big question is: Which facility can and should stroke patients be taken to first to get the right care within the right time span?
In Appalachia, about 11% of residents must drive more than 45 minutes to reach any kind of stroke center, according to the KHN and InvestigateTV analysis. That proportion is even higher in the Delta, where nearly a third of residents have to drive more than 45 minutes to a stroke center. Another third of Delta residents have only basic-care stroke centers within that distance and would need to drive farther for advanced stroke surgeries.