Servei de salut de les illes balears, Spain
A stroke is an acute vascular event that is associated with bleeding into the brain or decreased blood flow part of the brain. Both hemorrhagic and ischemic strokes may be treatable. Hemorrhagic strokes may be amenable to surgery (i.e. to remove blood clots or to clamp bleeding vessels). Ischemic strokes (approximately 85% of all cases) occur when there is decreased blood flow to a part of the brain and consequent cell death. During a stroke every minute counts and access to neurological care makes the difference between life and death.
The successful treatment of stroke requires the prompt identification of the cause and its characterisation by a stroke expert (neurologist). Reviews of the clinical evidence show that favourable outcomes are achieved if thrombolysis with tissue plasminogen activator (tPA) is administered within 90 minutes of the onset of symptoms and that positive benefits can still be achieved up to 270 minutes after the onset of symptoms.
The geographic divide between islands, combined with the shortage of available skilled neurologists makes the specialised evaluation and the use of tPA difficult. Stroke is one of the leading causes of mortality in the Balearic Islands. With only one hospital (the University Hospital Son Dureta located in Palma, Mallorca) specialised in stroke treatment, patients' access to timely care is the region’s major predicament.
This led Ib-Salut, the health authorities in the Balearic Islands, to explore innovative strategies to deliver timely treatment.
These strategies include the development of designated stroke centres, emergency services and hospitalary diagnosis and treatment protocols, and telehealth applications or “telestroke.”