The 2021 Rocky Mountain Stroke Conference was offered virtually in six individual 1-hour lunchtime sessions (April 22-May27). Each session has been recorded and posted below under the session title. These recordings are eligible for enduring continuing education credit until December 3rd. Printable Conference Flyer
Course Objectives & Upon Completion of the Activity:
- Participants will be able to describe specific clinical practices to improve care for stroke patients.
- Participants will recognize the importance of using a standardized team-based approach for stroke care in the acute and regional care settings.
- Participants will be able to describe new clinical practice guidelines and recommendations for acute ischemic stroke patients.
- Participants will be able to describe specific stroke prevention interventions.
Disclosure Statement/Criteria for Successful Completion/Continuing Education & Certificates:
For more information, scroll to the bottom of the page.
Thursday, April 22 - 12:00-1:00pm (MDT)
Building Stroke Systems of Care: The Good, the Bad, and the Ugly
Edward Jauch, MD, MS, FAHA FACEP, Chief of System Research, Mission Health - Asheville, NC
4/22/21 Session Recording
With varying levels of stroke center certifications and unique regional and geographic considerations, local Stroke Systems of Care (SSOC) designs and implementations vary widely. Regional stakeholders must collaborate to consider local prehospital and health care resources, individual stroke center performance, and geographic considerations to create an optimally adapted SSOC and destination protocol to ensure effective and efficient stroke care. This presentation will describe the foundations of SSOC and the mechanisms for working with all stakeholders to effectively create a SSOC for the citizens they serve.
Edward Jauch, MD, MS, FAHA FACEP joined Mission Health System in 2018, serving as Chief of System Research and the Director of the Mission Research Institute in Asheville, NC, and adjunct professor at the Medical University of South Carolina and the University of North Carolina-Chapel Hill in the Departments of Emergency Medicine and Neurology. Prior to joining Mission, Dr. Jauch was Professor and Chair, Department of Emergency Medicine, Department of Medicine, Professor, Department of Neurology, and faculty in the College of Graduate Studies at the Medical University of South Carolina (MUSC), and adjunct Professor of Bioengineering, Clemson University.
Dr. Jauch is active in numerous national organizations and research activities. Dr. Jauch served as the Chair of Stroke Council for the American Heart Association/American Stroke Association (AHA/ASA) and primary author for the 2013 Acute Ischemic Stroke guidelines. He is a co-author on the flagship AHA/ASA guidelines for telemedicine use in stroke, primary prevention of stroke, prehospital care of stroke, and stroke systems of care, as well as over 20 other AHA guidelines and scientific statements. Dr. Jauch serves on multiple national committees related to stroke care, including the Joint Commission Technical Advisory Committees. At the state level, Dr. Jauch served as the chair of the South Carolina Department of Health’s Stroke Advisory Committee and currently serves on the North Carolina Justus-Warren Heart Disease and Stroke Prevention Task Force. Collectively, these efforts have focused on improving access to care, increasing the quality of acute stroke care, and educating both the public and healthcare professionals on developing integrated stroke systems for care for all patients.
Adeoye O, Nystrom KV, Yavagal DR, Luciano J, Nogueira RG, Zorowitz RD, et al. Recommendations for the establishment of stroke systems of care: A 2019 update. Stroke. 2019;50:e187-e210
Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American Heart Association/American stroke association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: A guideline for healthcare professionals from the American Heart Association. 2015;46:3020-303
Saver JL, Goyal M, Van Der Lugt A, Menon BK, Majoie CBLM, Dippel DW, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: Ameta-analysis. JAMA - Journal of the American Medical Association. 2016
Thursday, April 29 - 12:00-1:00pm (MDT)
Setting Patients Up For Success: Prehospital Stroke Recognition and Treatment
Jeff Welch, NRP, EMSTC, Critical Care Paramedic, Field Paramedic Supervisor and Assistant Manager, Missoula Emergency Services, MT
4/29/2021 Session Recording
The field recognition and treatment of the CVA is paramount in the process of decision-making care. The discussion will center on the role of the EMT and Paramedics in the field and how early recognition helps patients have the best outcome.
Jeff Welch has been involved with EMS since the 90's working mostly in Montana. He was in the fire/ems system for about 11 years and then took the role of Street Paramedicine. He has been on the education side of EMS for over 20 years. He is passionate about education and providing good patient care. He has done all of his education including Critical Care Paramedic in Missoula. He loves cross-fit, hiking, Golf, Softball, and all kinds of outdoor activities. He enjoys all of these activities with his wife, 3 kids, and his two Dachshunds.
Caroline, N. (2014). Nancy Caroline's emergency care in the streets (Revised 7th ed.). Jones & Bartlett Learning. Division of Heart Disease and Stroke Prevention, https://www.cdc.gov/chronicdisease/index.htm, Guidelines for Early Management of Patients with Acute Stroke (2019).https://www.ahajournals.org/doi/10.1161/STR.0000000000000211
Thursday, May 6 - 12:00-1:00pm (MDT)
Mechanical Thrombectomy to Improve Patient Outcomes in Stroke
Christopher M. Zylak, MD, Interventional Radiologist, Inland Imaging - Spokane, WA
5/6/21 Session Recording
The discussion will be centered on Mechanical Thrombectomy with an emphasis on rural systems of care, determining eligibility, transfers, communication, improving patient outcomes, case studies.
Christopher M. Zylak, MD is a practicing Vascular & Interventional Radiologist in Spokane, WA. Dr. Zylak graduated from Queen's University Faculty of Health Sciences in 1996 and has been in practice for 22 years. He completed a residency at the University of Arizona College of Medicine. Dr. Zylak also specializes in Diagnostic Radiology. He currently practices at Inland Imaging Associates and is affiliated with Sacred Heart Medical Center and Valley Hospital & Medical Center. Dr. Zylak accepts multiple insurance plans including Aetna, Medicare, and Cigna. Dr. Zylak is board certified in Diagnostic Radiology. Dr. Zylak also practices at Inland Imaging in Spokane, WA.
Aghaebrahim A, Sauvageau E, Aguilar-Salinas P, et al - Referral facility CT perfusion prior to inter-facility transfer in patients undergoing mechanical thrombectomy, Journal of NeuroInterventional Surgery 2018;10:818-822.
Asif KS, Lazzaro MA, Zaidat O - Identifying delays to mechanical thrombectomy for acute stroke: onset to door and door to clot times, Journal of NeuroInterventional Surgery 2014;6:505-510.
Thursday, May 13 - 12:00-1:00pm (MDT)
The Sleuthy-Stroke Caper – A Who’s Who of Who Done It!
Jason Gleason, MSN, NP-C, USAF Lieutenant Colonel (RET) - Great Falls, MT
5/13/21 Session Recording
BREAKING NEWS: A world-renowned stroke expert has been stricken with a stroke! Suspects are still at large! Can the audience help Detective Gleason save the day and solve the mystery of the sleuthy-stroke caper? Audience members will be taken through a fun, immersive, and informative journey empowering them with information and tools related to stroke prevention. Sleuthy Stroke Caper Billboard Flyer
Jason Gleason MSN, NP-C has been a Registered Nurse since 1994 and a Board Certified Family Nurse Practitioner since 2001. He has an expansive leadership and practice portfolio including Occupational Health, Family Practice, Emergency Medicine, and most recently as a Stroke Care Consultant and National Speaker on promoting and advancing stroke care. Gleason also served for twenty years in the Air National Guard prior to retiring as a Lieutenant Colonel in 2015. During his time with the Air National Guard, he served as Officer in Charge of Health Promotion, Medical Readiness, Staff Development, and as Assistant Chief Nurse. Gleason currently works in Primary Care serving our national heroes through the Veteran’s Administration in addition to working in an Emergency Department of a Level II Trauma Center while continuing his work as a professional speaker and consultant advancing exceptional stroke care. Gleason’s top job is that of being a great father and husband.
Gurol, M. E., & Kim, J. S. (2018). Advances in Stroke Prevention in 2018. Journal of Stroke, 20(2), 143–144. doi: 10.5853/jos.2018.01438
Powers, W., Rabinstein, A., Ackerson, T., Adevoe, O., Bambakidis, N., & Becker, K. (2018). 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Journal of Vascular Surgery, 67(6), 1934. doi: 10.1016/j.jvs.2018.04.007
Thursday, May 20 - 12:00-1:00pm (MDT)
Stroke Care in the Frontier
Todd Mohr, PA-C, Physician Assistant, St. James Healthcare - Butte, MT
5/20/21 Session Recording
This session will discuss the identification and care of a stroke patient with limited resources.
Todd Mohr, PA-C is a Physician Assistant working at St. James Healthcare in Butte. He has worked in the Emergency Department at St. James for 15 years. Todd grew up in Deadwood, South Dakota and became interested in helping others as a teenager when he joined the Volunteer Fire Department at age 14 as a Junior Volunteer. He became an Emergency Medical Technician and worked on the Ambulance at age 16. He joined the US Air Force at age 17 as a Fire Protection Specialist and quickly rose through the ranks. Todd served primarily as a Rescue Crew Chief and was responsible for motor vehicle accident patient extrication, aircraft crash pilot rescue and was assigned to the Space Shuttle Rescue Team while stationed in Germany. He completed the Air Force Physician Assistant Program 25 years ago and was assigned to Malmstrom AFB in Great Falls, Montana. He thoroughly enjoys the opportunities that Montana provides his family to spend time together in their passion for golfing, skiing, and hunting. His other noted patient care experiences include serving as a SWAT Medic and on Helicopter EMS. Todd is the Medical Director for several Volunteer EMS Services in Southwest Montana and believes it is his way to “give back to his roots,” which has allowed him to have the “most blessed career experiences in the world!”
American Stroke Association, https://www.stroke.org/en/professionals/stroke-resource-library/prevention/prevention-materials
Journal of Emergency Medical Services, Implementation Strategies for Emergency Medical Services Within Stroke Systems of Care, A Policy Statement From the American Heart Association/ American Stroke Association Expert Panel on Emergency Medical Services Systems and the Stroke Council, Originally published27 Sep 2007https://doi.org/10.1161/STROKEAHA.107.186094Stroke. 2007;38:3097–3115
Thursday, May 27 - 12:00-1:00pm (MDT)
Post-Stroke Rehab: Tackling Barriers to Care and Return to Community
Alicia Fuhrman, MD, Physiatrist, St. Luke's Rehabilitation Institute - Spokane, WA
Jennell Taylor, RN, Case Manager Supervisor, St. Luke's Rehabilitation Institute - Spokane, WA
5/27/2021 Session Recording
Session Slides - PDF Handout
After a stroke, receiving multidisciplinary therapies in an inpatient rehabilitation setting has been associated with greater improvement in function as well as better long-term outcomes, lower mortality, and lower rates of re-hospitalization. However, numerous clinical, logistical, and financial barriers can limit access to this type of care. Our purpose is to describe methods for addressing, reducing, and/or removing these barriers, as well as to list solutions to common problems in post-stroke rehabilitation care. We do this by utilizing the strengths of the multidisciplinary rehabilitation team and facilitating clear and consistent communication to help provide the best patient care possible. As a result, our facility is able to discharge a high percentage of stroke survivors to community settings.
Alicia Fuhrman, MD graduated with honors from Baylor University in Waco, TX prior to attending the University of Texas Medical School at Houston, now the McGovern Medical School. She completed residency training in Physical Medicine and Rehabilitation at the University of Washington. Her areas of interest include medical ethics, quality improvement, and patient safety. In her free time, she enjoys running, hiking, and spending time with family.
Jennell Taylor, RN has been working in rehab since 2003. She started as a NAC while working her way through nursing school and fell in love with the rehab population. Jennell works with stroke and brain injury patients but found her passion in the spinal cord population in 2005. In 2010, she moved into case management at St. Luke’s assisting with the discharge of patients to the community. Six years later moved to another area of case management assisting St. Luke’s admission from the neurology floor at Providence SHMC. She is now working as a supervisor for the case management team sharing her knowledge and 17 years of rehab experience throughout the continuum for rehab and stroke patients.
Hong et al. Comparison of functional status improvements among patients with stroke receiving post acute care in IRF vs SNF. Jama December 4, 2019. IRF associated with greater improvement in mobility and self-care compared with care in SNF, and significant difference in functional improvement.
Belagaje et al. J Neurointerventional Surgery 2015;7:322-325, Bettger JP et al. stroke 2015;46:A146. Chan L et al. Archives of Phys Med Rehabil 2013;94(4):622-629.
Kumar A et al. Archives of Physical Medicine Rehabil 2019;100:1218-25.
The AHA guidelines for stroke rehabilitation and recovery clearly recommend inpatient rehabilitation for patients with CVA who meet criteria, and multiple research studies have documented that long term outcomes, mortality, and re-hospitalization rates for patients with stroke are better with intensive inpatient rehabilitation programs than with skilled nursing facility placement
There is also research that shows that patients who undergo endovascular reperfusion therapy who discharge to IRF have a higher probability of achieving a good neurologic outcome (Belagaje SR, et al. J NeuroIntervent Surg 2015;7:99–103.) There is also research that shows that patients who receive intensive speech therapy for aphasia have significantly improved effective communication ability compared to those that do not (Breitenstein, C et al Lancet 2017; 389:1528-1538).
Disclosure Statement - Criteria for Successful Completion - Continuing Education
There is no conflict of interest for anyone with the ability to control the content of this activity except for Dr. Christopher M. Zylak, who has been a speaker and proctor for Medtronic.
Criteria for Successful Completion & Certificates:
Contact hours awarded based on full attendance of session / or viewing the entire recorded webinar (Enduring CME)
Complete the Online Evaluation Form following the activity (Evaluations will remain open until December 3, 2021)
**PLEASE NOTE – In order to receive a CE Certificate of Attendance from the conference, you must complete the online evaluation for each session (link will be provided in recordings, copy and past into a browser). Once completed, you will have the option to provide an email for the certificate to be automatically sent (if the organizational email has a strong firewall, please use a personal email to ensure certificate delivery). Please email the conference coordinator, Michelle Eckert if you have any additional questions.
This activity has been planned and implemented in accordance with the accreditation requirements of the Washington State Medical Association through Providence Health Care. Providence Health Care is accredited by the Washington State Medical Association CME Accreditation Committee to sponsor continuing medical education activities for physicians.
Providence Health Care designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This activity meets the criteria for up to 6 hours of Category I CME credit to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission.
**CME credits can be used for renewal hours for Emergency Care Providers