Emily’s life is saved by telestroke

Emily Sletten-Williams, 21, lives in Port Pirie in South Australia and is a mother to Peyton, 3. On a normal Saturday morning, Emily tried to vacuum her home, despite a slight tingling in her arm. She persevered and completed the job but then was unable to wind up the vacuum cleaner cord. She kept dropping Peyton’s dummy and started to feel “really strange”. Emily tried to text her husband, Codie, who was in the bathroom, but he couldn’t understand the garbled message.

Husband Codie, Peyton, 3, and Emily post-stroke

Fortunately, the couple lives around the corner from Port Pirie Hospital and Codie took Emily there within minutes.

While standing in Emergency and providing her details, Emily fell.

Hospital staff were quick to recognise the signs of stroke and raced Emily to have a CT scan so they could determine whether she had a bleed or a clot in her brain.

A call to the SA Telestroke Service ensured Dr Matt Willcourt in Adelaide could study the images from the CT, accurately assess the situation, diagnose and then recommend the correct treatment to be given by the Port Pirie team. In Emily’s case, a clot-busting medication was given – just 79 minutes after the stroke symptoms began. The decision was made to fly her to Royal Adelaide Hospital in case she needed surgery to physically remove the clot.

“I couldn’t speak but I remember some of the helicopter flight, landing and being wheeled straight past the ED and into surgery,”

Emily could be fast-tracked to a thrombectomy team who were primed, ready to remove the clot.

Once back on a stroke ward, Emily began to speak and regain the use of her arm. Visits from a range of specialists followed – a speech pathologist, occupational therapist, physiotherapist, psychologist, a counsellor, neurologists…all who declared Emily well. Remarkably, Emily was able to go home to Port Pirie two days later – with no aftereffects of the stroke.

Looking back, Emily had symptoms that went undiagnosed – black spots in her left eye for two years, momentary speech problems which probably happened during minor strokes known as TIAs, and blanks when she couldn’t answer simple questions.

Her neurologist, Professor Tim Kleinig, explained some scarring on her brain scans which, along with blood tests, helped explain why a young woman would experience a significant stroke. Emily has been diagnosed with Antiphospholipid syndrome, which affects blood-clotting and the immune system. She takes Warfarin daily.

“I was just so startled and confused by the stroke because I was a pretty healthy 20-year-old girl. I never thought it could happen to me – everyone thinks stroke happens to elderly people.”

Today, as well as caring for Peyton, she works as a ward assistant at the Port Pirie Hospital where staff in the ED sometimes ask “What are you doing here?”.

“I tell them I’m fine and that I work here!”

Emily’s story exemplifies the importance of a fast medical response when stoke is suspected, wherever the patient lives.

Because she lives in a town 230km away from Adelaide, Emily’s stroke may have been difficult to treat without the help of the SA Telestroke neurologist in Adelaide who, using the Stroke Alliance-built telehealth platform, could look at Emily’s brain scans and work alongside the doctors in Port Pirie.

Emily’s case exemplifies the partnership between the Australian Stroke Alliance and Titan Prehospital Innovation’s telestroke platform and SA Health Rural Support Service’s SA Telestroke Service.

The Titan team developed a cost-effective telehealth platform that meets SA Health’s specific requirements, ensuring patients in rural and remote locations have fast access to expert neurological care.

Emily, preparing to be airlifted by helicopter from Port Pirie to Adelaide

An exemplar: South Australia

SA Health leads the nation in fast treatment of rural and remote stroke patients – an essential objective for all health services aiming to minimise the damage caused by stroke.

The SA Rural Support Service is treating double the national average of patients within 60 minutes of hospital arrival. This sustained improvement follows the introduction of specifically designed telestroke which was introduced in 2022, supported by the Stroke Alliance and Titan Prehospital Innovation.

The telestroke service delivers statewide, urgent access to a neurologist who assesses the patient at the scene of the stroke before deciding the best treatment pathway.

In 2022, 38 per cent of patients in rural and remote locations received thrombolysis within 60 minutes. Today the figure is a nation-leading 54.5 per cent. Some 27.2 per cent are actually thrombolysed within 45 minutes.

As well, following the introduction of SA Health’s telestroke service in the Northern Territory, Darwin is the second most active telestroke site with Alice Springs third. A significant number of NT patients have been assessed by remote neurologists working for the SA telestroke service, allowing SA Health and the Stroke Alliance to undertake quality improvement program to ensure more patients are treated within 60 minutes. In fact, the Royal Darwin Hospital team has just recorded its first patient to be thrombolysed at 47 minutes from arrival.

in 2024:

  • Some 59.8 per cent of rural patients presenting with stroke-like symptoms were diagnosed with a stroke
  • Some 78 per cent of all consults did not require a transfer to Royal Adelaide Hospital
  • Unnecessary hospital-to-hospital transfers have been cut by 72 per cent
  • Some 55 per cent received thrombolysis within 60 minutes (median time from hospital arrival to thrombolysis is 95 minutes)
  • Double the number of patients have been treated with life-saving thrombectomy
  • In Mt Gambier, 45 per cent were thrombolysed within 60 minutes
  • A total of 109 patients had thrombolysis and 33 underwent endovascular clot removal
  • A total of 54 cases were recommended for endovascular clot removal after expedited transfers
  • Overall, telehealth patients receive life-saving treatment up to 30 minutes faster
  • For the first time in SA, patient data is in one place, fast-tracking neurological care across 61 hospitals as well as Alice Springs Hospital and after hours services for Royal Darwin Hospital.

The Stroke Alliance is keen to support other states and territories to develop cost-effective, adaptable telestroke platforms which can slot into existing systems at a fraction of the cost of “off the shelf” technologies.

According to Dr Craig Kurunawai, the rural clinical lead for stroke within SA’s Rural Support Service: “The data extracted from the telestroke platform is highly valuable in building the Statewide Telestroke dashboard (for monitoring of stroke metrics) and organising regular feedback or reporting to regional hospital clinicians. In these last two months there have been a few quality improvement initiatives which we hope will further improve our thrombolysis metrics.”

In a recent case when a 54-year-old South Australian labourer experienced a stroke, the SA telestroke pathway returned him to full health, avoiding an estimated $5.5 million in long-term hospitalisation and disability care.

Commenting on the case, Professor Tim Kleinig, the head of the Royal Adelaide Comprehensive Stroke Unit, said: “Just this one case, alone, pays for the whole SA Telestroke Service for a year in terms of societal and economic benefit”.