Stroke patients in remote Australia can’t reach hospital in time

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It takes a median time of almost four hours to get stroke patients to hospital from remote areas in Australia using the Royal Flying Doctor Service. Without air transport, it can take up to 11 hours.

But to reduce death and disability from stroke, patients need to be treated more quickly. Doctors aim for treatment within the ‘golden hour’ – the first hour after a stroke.

Indigenous Australians are disproportionately affected by delays getting to hospital. Although they make up 3 per cent of the population, they represent 16.5 per cent of Flying Doctor air retrievals for stroke.

These findings come from an analysis of data from the Flying Doctor. The organisation provides medical care to people in Australia who can’t access hospitals by road because they live too far away. These parts of the country are also beyond the reach of emergency response helicopters.

The research team included University of Melbourne researchers at the Melbourne Brain Centre and the Royal Melbourne Hospital. Professor Stephen Davis and Professor Geoffrey Donnan were the senior doctors on the team.

Strokes are a leading cause of death and disability. Each year, they affect more than 13 million people and cause 5.5 million deaths worldwide. Strokes cut off blood supply in the brain, which deprives the brain cells of oxygen. The longer treatment is delayed, the more damage the stroke can cause.

No single treatment works for all types of stroke. Some require clot-busting drugs. Other types need  measures to control bleeding in the brain. To work out which treatment is needed, doctors perform a computed tomography (CT) scan on the patient’s brain in a specialised stroke unit. But these units are usually in major cities or highly populated regional areas. About one-tenth of Australia’s population – more than 2 million people – live outside these areas.

The research team analysed data from 1773 Flying Doctor air transfers for stroke patients from 1 July 2014 to 30 June 2018.

The data also reflected known health disparities between Indigenous and non-Indigenous Australians who experience a stroke. The average age of Indigenous stroke patients transferred by the Flying Doctor was 56. Non-Indigenous stroke patients had an average age of 66.

For all stroke patients, the median transfer time was 238 minutes. This is the time from the Flying Doctor receiving the first call to the patient arriving at the hospital. The median time for road transfer in metropolitan areas is 150 minutes.

Next steps

Through the Australian Stroke Alliance, University of Melbourne researchers are exploring the development of imaging devices that are lighter and cheaper than hospital CT scanners, for use on Flying Doctor aircraft. Their goal is to reduce the time it takes to get a diagnosis, so that treatment can start earlier. The Australian Stroke Alliance estimates that improving the delivery of pre-hospital stroke care would reduce the stroke burden in Australia by more than 30 per cent in the next 30 years. It could also save the economy and healthcare system nearly $A55 billion by 2050.

Funding

Medical Research Future Fund, Frontier Health and Medical Research Program (MRFF75781)

Victorian Department of Health and Human Services

Publication

Gardiner FW et al (2020) Aeromedical retrieval for stroke in Australia. Cerebrovascular Diseases 49: 334–340. doi: 10.1159/000508578

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