Time is brain for Dr. Ritesh Kaushal.
For every single minute Kaushal — an interventional neurologist and director of the Comprehensive Stroke Center at Palmetto General Hospital — wastes in getting to the hospital, the stroke victim lying on his operating table loses about two million brain cells.
“It’s challenging, particularly in South Florida,” Kaushal said, referring to Miami-Dade’s snarling traffic. “A 14-minute drive can easily change to 45 minutes or more.”
To expedite the process, Palmetto General Hospital partnered with the city of Hialeah police and fire departments to install a siren and emergency lights in Kaushal’s car.
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“This is something new that we’ve done. If we can get the doctor to the hospital quicker, we can save brain function and have better patient outcome; a better chance to resume a normal life and to recover,” Hialeah Fire Chief Miguel Anchia said.
So far, Kaushal has used the siren three times in three weeks. He said being able to zip through bumper-to-bumper traffic in South Florida is “priceless.”
“We already see results. Last week, on a Sunday, construction was going on on I-75 — four lanes were closed off, one lane open. Those three miles would have taken me around 30 minutes,” Kaushal said. “But I used the siren.”
It’s not the sirens or the lights that excite me, but it’s being able to get the clot out in time and seeing them being able to talk and move again.
Ritesh Kaushal, interventional neurologist at Palmetto General Hospital
The doctor said a 56-year-old man had arrived in a “locked-in” condition.
“That’s where you cannot move anything below your eyes,” he said. “They call it the perfect prison; your body becomes your jail. You can see and hear but you cannot move. You cannot breathe and end up living like a vegetable. If it wasn’t for that siren, he probably would have stayed that way and lived in a nursing home forever. I was able to take the clot out of his brain and he went home four days later.”
Days from each other, Kaushal used the siren to treat an 80-year-old man and a 57-year-old man. They both went home walking.
But the red and blue lights come with rules.
“He’s not a police officer or an EMT, so he needs to abide by regular traffic laws,” Anchia said. “He can’t take red lights or drive on the opposite side of the street. Yes, he can use emergency lanes. The siren is a tool that will allow drivers to make way for him as he makes his way to the hospital.”
In recent years, local hospitals, EMS officials and the American Heart Association/American Stroke Association have stepped up efforts to reduce the time it takes from when a person exhibits signs of a stroke to the time they are treated at a hospital.
The universal goal is for EMS personnel to recognize stroke symptoms — including slurred speech, face drooping and arm weakness — and call a stroke center so that a team is ready when the patient arrives at the hospital.
Strokes, which can be caused by a blocked artery or a blood clot, cut off blood to the brain, depriving it of critical oxygen and valuable nutrients. And even if patients are administered the clot-busting drug tPA within a three- to four-hour window, only about 30 percent will see their conditions improve, medical experts say.
Kaushal said since 2013 the hospital has significantly reduced “door to needle” by working directly with EMS and being prepared as soon as a patient arrives. In 2013, the hospital’s “door to needle time’’ was 72 minutes, in 2015 it was 29 minutes, and this year it was 27 minutes. The average time in Florida is 52 minutes; the national average is 76 minutes.
As part of Palmetto General’s effort to improve patient outcomes, EMS now calls Kaushal directly from the patient’s house, instead of calling when they arrive at the hospital, saving another 15 to 20 minutes.
“It’s not the sirens or the lights that excite me, but it’s being able to get the clot out in time and seeing them being able to talk and move again,” Kaushal said. “It’s a huge reward. The lights just help me get there faster and help save the brain cells.”