Alice Springs: Statement on the Future of Stroke Care
Central Australian health professionals provided valuable insight into urgent stroke care when Australian Stroke Alliance members visited Mparntwe (Alice Springs), on Arrernte Country recently. While we introduced our Golden Hour program to those who work in the field, we were grateful to hear of successes and inevitable obstacles from those responding to acute stroke patients, across vast stretches of Australia’s outback.
Delegates of the one-day summit shared a mission: to improve stroke outcomes for rural and remote Australians. As well, the group recognised that access to urgent therapies is critically inadequate when compared with the services available to those living in metropolitan settings.
Notably, the discussions overcame state and territory borders and built strong networks of people ready to introduce emerging technologies. Representatives from Central Australia’s retrieval service (Medical Retrieval and Consultation Centre – MRaCC), the Royal Flying Doctor Service, CareFlight (NT), and St John Ambulance (NT) discussed how retrieval systems can work together to build on current protocols to serve Central Australia’s 500,000sqkm population.
The heart of Central Australia’s health system, Alice Springs Hospital, will provide a template for improvement of stroke care around the country, particularly under the leadership of senior staff specialist and head of the Department of Medicine, Dr Anna Holwell, and with the dedicated support of the hospital’s general manager and director for Acute Care Services, John Swiatczak-Steele.
Stroke incidence is 20 per cent higher in rural and remote areas with double the likelihood of significant lifelong disability than those who have a stroke in a metropolitan area. The tyranny of distance means rural and remote patients take longer to reach hospital and suffer poorer outcomes as a result. As well, stroke disproportionality affects Aboriginal and Torres Strait Islander communities with a stroke incidence rate that is 2-3 fold that of non-Indigenous Australians, and the figures for those under 55 are worse (6-9 fold). Onset is 10-30 years younger and those affected are less likely to receive secondary prevention or rehabilitation services. The mortality rate is 3-5 fold that of non-Indigenous Australians.
Australian Stroke Alliance
Co-chairs, Professors Stephen Davis and Geoffrey Donnan introduced the Stroke Alliance’s emerging influence – bringing together more than 40 national agencies committed to transforming prehospital stroke care. They explained the way we integrate clinical, academic, scientific, paramedical, consumer, referral and retrieval services, with commercial biotech, to improve the delivery of urgent stroke care for all Australians.
Neurologists Dr Anna Balabanski and Angela Dos Santos presented data on the incidence of stroke and its impact on Indigenous communities. Dr Holwell spoke of her plans for comprehensive stroke care at the Alice Springs Hospital. Skye Coote, a stroke nurse practitioner, explained the alliance’s education program and ways staff could participate.
Following afternoon panel discussions on Indigenous health and opportunities to build-on existing retrieval pathways, a consensus document was written, acknowledging the knowledge shared with the Stroke Alliance, and action to be taken in Alice Springs as part of the Golden Hour research program.
Prof Stephen Davis added: “Ultimately, this will result in increased numbers of patients receiving optimal stroke care with improved patient experiences and outcomes. We also acknowledge the potential for these initiatives to improve stroke services in other rural and remote regions, and how this framework could be applied to other diseases in rural and remote areas”.
Beyond immediate patient care, there is a vision to attract research funding, projects and personnel, further enhancing Alice Springs Hospital’s influence.
Stroke Alliance senior clinical research fellow and Australia’s first Indigenous neurologist, Dr Dos Santos, said: “We privilege Indigenous knowledge and will work together to develop culturally safe, evidence-based strategies to improve access to acute stroke therapies for First Nations Australians”.
A set of agreed actions emerged and they are summarised, below, separating those within the Australian Stroke Alliance’s mission and some covering primary prevention, health promotion and rehabilitation, for others to consider.
Australian Stroke Alliance and Alice Springs Hospital actions:
- Build new connections across the workforce – including those in towns, regional and remote clinics, GPs and other remote health practitioners, remote hospital clinicians, retrieval services and virtual health providers
- Develop a Central Australian Stroke working group that brings together multidisciplinary leaders from community, primary health care, retrieval and hospital
- Led by the Stroke Alliance’s dedicated Indigenous research network, Darak, hospital Aboriginal Liaison Officers, and local communities, privilege Indigenous knowledge and facilitate development of specific, culturally safe, evidence-based strategies to enhance access to acute stroke therapies for First Nations Australians
- Drive education in prehospital response, as it is fundamental to improving stroke care
- Provide remote communities with knowledge and understanding, and resources to enable an efficient and effective response to stroke
- Contribute to expanding Alice Springs Hospital Research hub through supporting local stroke research, including in allied health areas.
While not core to the Stroke Alliance’s mission, other important initiatives were considered crucial to our success and were noted on the consensus document:
- Advocate for improvements in communication across the sector – from mobile phones to infrastructure – an urgent priority
- Advocate for staff recruitment in Central Australia Health Services – one of the biggest barriers to improving health services and outcomes
- Led by local communities:
- Create community awareness of stroke through future yarn-up sessions
- Contribute to strengthening Aboriginal health workers, Aboriginal health practitioners and hospital-based Aboriginal liaison officers working in stroke
- Ensure easily available education resources are culturally appropriate, and that they cover the entire stroke journey from primary prevention and health promotion to post stroke rehabilitation.
The Stroke Alliance thanks those who participated particularly, Dr Holwell, Dr Mardi Steere, GM of Medical and Retrieval Services (SA and NT) for the RFDS, Dr Dan Adams, director of Retrieval for MRaCC, and Sharon McGowan, CEO of the Stroke Foundation.
Read more highlights from the summit from the Darak team here.