Act F.A.S.T.: Calling 911 saves Louisiana man's life after stroke
By Kristy Bleizeffer Oct 23, 2019
Glenn Gallet of Breaux Bridge, La., arrived at Wyoming Medical Center unable to speak, paralyzed on his right side and not understanding what people said to him. Left untreated, the clot in his left middle cerebral artery, would have likely killed him or left him permanently disabled.
But, within 59 minutes, the clot had been removed and Glenn wiggled the fingers on his paralyzed hand.
“Beyond the flawless performance of the stroke team, starting with EMS, the real reason there is a happy ending to this story was the recognition of stroke symptoms and quick thinking of Glenn’s friend who called 911,” said neurologist David B. Wheeler, MD, PhD, FAAN, FAES, medical director of WMC’s Primary Stroke Center.
“Glenn's friend truly acted F.A.S.T. and definitely saved his life.”
Stroke care is measured in minutes. Time is brain, the saying goes, and the faster doctors open the blocked blood vessel, the better the chance of survival and recovery. From the moment Glenn’s friend called 911 to the moment Charles Bowkley, M.D., a neurointerventional radiologist, pulled the clot from his brain, Glenn’s case is the culmination of a system of care our primary stroke team has built over more than a decade. Now, we are working to extend this fast, life-saving care to every stroke patient who needs it, not just in Casper but across the state.
Though Glenn, 70, lives in Louisiana, he is starting a business in Casper with two friends and has spent considerable time here. On June 10, he’d just recently returned after several weeks back home to attend graduation parties for two of his grandsons.
He felt good when he went to bed about 9:30 p.m. But early the next morning, he fell on his way back from the restroom. He thought little of it and fell back to sleep. He awoke for good a few hours later and went to take a shower.
“Next thing I knew, I was flat on the floor in the bathroom. I was out for maybe 10, 15 minutes,” he said.
When he came to, he tried to make it to his bedroom and shake it off. He fell again, this time breaking the night stand. He couldn’t hear himself talk, and he couldn’t call out for help. He tried to use his cell phone but couldn’t manage the touch-screen buttons.
Amongst his friends, Glenn is usually the first one up and around. When he didn’t come upstairs that morning, his friends called down to the basement for him. When he didn’t answer, they called his cell phone.
Glenn couldn’t respond, and his friend rushed down to him. Glenn was confused and his speech was garbled. His friend called 911 at 8:41 a.m.
‘Time is Brain’
Calling 911 at first sign of symptoms is the single most important step in getting stroke treatment in time, Dr. Wheeler said. EMS is the first piece in the stroke system of care that involves nearly every department of the hospital. EMS activates our stroke team, so they can mobilize as the patient is transported to the hospital, and it leaves no chance for delay in the waiting room.
Paramedics immediately recognized Glenn’s stroke symptoms and called Dr. Wheeler, activating Code Stroke from the field. He arrived at Wyoming Medical Center at 8:49 a.m., eight minutes after the 911 call.
“By the time Glenn got to the hospital, the entire stroke team was assembled and ready to intervene,” Dr. Wheeler said. “We took him directly from the ambulance to radiology and performed a stroke protocol CT.”
Stroke protocol computed tomography scan is special type of CT scan that can show whether a large vessel is blocked and whether the part of the brain that is deprived of blood is permanently damaged or at risk of becoming so. In Glenn’s case, the stroke team saw that while a small amount of permanent damage had occurred, the vast majority of the brain could still be saved. His best chance for a good recovery was to remove the clot and restore blood flow through mechanical thrombectomy, a procedure that physically pulls the clot from the blocked blood vessel.
Glenn was immediately taken to the interventional radiology suite and prepped for treatment.
At 9:24 a.m., 35 minutes after arriving at the hospital, Dr. Bowkley inserted a guidewire and small catheter into Glenn’s right femoral artery. Guided by real-time X-ray imaging called fluoroscopy, Dr. Bowkley directed the catheter to the left side of Glenn’s brain and into the cerebral artery. He deployed a specialized device called a stent retriever, ensnared the clot and pulled it out.
Almost immediately, Glenn wiggled his right fingers.
“With one pass of the device, the clot was removed. From Mr. Gallett’s entrance to the hospital until we re-established complete and normal flow to his brain, fewer than 60 minutes elapsed. When time is brain, every second counts,” Dr. Bowkley said.
“Strokes like Mr. Gallet’s represent true life-threatening emergencies that, until recently, medical professionals have struggled to effectively treat. With the recent advances in minimally invasive interventional devices, we can now safely and rapidly restore blood flow to the brain. Words are incapable of describing the whirlwind of emotions involved in participating in successful stroke care. I am truly humbled and honored to participate as a member of the team.”
Even a few years earlier, Glenn’s treatment might have looked very different.
“Several changes in our stroke care process and advances in technology meant Glenn had a much better outcome than he would have a few years ago,” Dr. Wheeler said.
First, Wyoming Medical Center implemented pre-hospital notification to activate Code Stroke based on EMS assessment, mobilizing the care team much faster.
Second, advances in device technology mean the team can reliably remove clots from the large vessels in the brain. These devices were not nearly so dependable even five years ago.
Third, and most recently, we have started using RAPID analysis of the CT images which helps physicians determine whether there is still brain alive that can be saved. Before this system was in place, mechanical thrombectomy was only available to patients whose stroke symptoms were known to have begun within the past six hours.
“In Glenn's case, we would not have been able to make this determination and so would not have been able to offer treatment,” Dr. Wheeler said.
Finally, standard-of-care guidelines for using mechanical thrombectomy have extended the time window to up to 24 hours for some stroke patients. This means more stroke patients in Wyoming could benefit from the treatment – if they are able to get to Wyoming Medical Center in time.
Wyoming Medical Center is the state’s first Primary Stroke Center certified by the Joint Commission. We are the only hospital with 24-hour coverage by an interventional radiologists, the specialists that make clot retrieval, or mechanical thrombectomy, possible. Through our TeleStroke Wyoming program, we have partnered with hospitals in Gillette, Sheridan, Douglas and Thermopolis to install TeleStroke robots and standardize care and identify more patients who could benefit from this type of treatment and transport them to Wyoming Medical Center in time. We hope to have the TeleStroke robots in 10 Wyoming hospitals by the end of the year.
“Right now, we are building a system of care across the state to help every hospital get as good at stroke care as possible,” Dr. Wheeler said. “Our goal is that every person in Wyoming should have ready access to comprehensive stroke care, no matter if they live near Basin or Gillette or Casper.”
Treated like family
Glenn and his wife, Linda, have been married for 41 years. They have three sons.
Linda was home in Louisiana when Glenn’s friend called her from Wyoming Medical Center. Her sons coordinated travel plans to Casper and took her to the airport. She arrived in Casper at 8:30 the night of the stroke.
“It was scary, not knowing the extent of everything. I just couldn’t function. I felt like I was in a haze, a fog,” Linda said. She remembers that Dr. Wheeler called during her travels to tell her Glenn’s clot had been removed, reassure her and answer her questions. At the hospital, Dr. Bowkley came in to explain the whole procedure. That level of personal care, from the staff to the physicians, helped ease her worry, she said.
Glenn spent three days on the WMC Neuro Unit and then spent about two weeks at Elkhorn Rehabilitation Hospital. While they are not thankful Glenn suffered a severe stroke, they are grateful that he was in Casper when it struck.
“Oh my goodness, the people on Neuro are like a family. Anyone who walked in the room, it didn’t matter what their job was or what their title was, if we asked a question, they went and tried to find an answer. It makes you feel like you aren’t just a patient, but you’re a person,” Linda said. “My feelings are that he was in the right place at the right time. We feel fortunate because we don’t have this level of care at home.”
Glenn says he couldn’t have asked for better care than he found in Casper. Before his discharge from WMC on June 13, he had one last question: Could he go back to work?
“Of course you can,” Dr. Wheeler answered. “And if you come back to Wyoming, you better come say, ‘Hi.’”
Dr. Wheeler is board certified in neurology, epilepsy and clinical neurophysiology. He is a Rhodes Scholar and the 2019 American Heart Association Physician of the Year. He serves on the boards for Wyoming Dementia Care and the American Heart Association (Southwest Affiliate.) He is director of the Wyoming Epilepsy Center and medical director of the Wyoming Medical Center Primary Stroke Center. His private practice is Wyoming Neurologic Associates, 2546 E. Second St. #600. Call (307) 265-4343 for a referral or appointment.
Dr. Bowkley is a neurointerventional radiologist and Wyoming Medical Center’s 2017 Physician of the Year. He is board certified in diagnostic and vascular / interventional radiology. He practices at Casper Medical Imaging in Casper. Call 307-232-5054 for an appointment or referral.