Imagine coming home one day to find your significant other collapsed on the floor and unable to speak or move one side of his or her body, seemingly experiencing a severe stroke. Would you want your loved one to go to a hospital that has some degree of stroke expertise, or would you rather he or she be taken to a Level 1 stroke center that is equipped to handle the most life-threatening strokes 24/7, 365 days a year?

As daunting as this decision sounds, first responders nationwide are forced to make this judgment call every day. Most states do not have specific protocols currently in place that ensure someone who is experiencing a severe stroke is transported directly to a Level 1 stroke center with access to a highly trained neuroendovascular team that can help every minute of every day.

While patients might live near a hospital that is best equipped to treat them, they will likely be transported to another one simply because it’s closer — only to be transported to a second or, perhaps, a third facility. The time lost in transferring patients from the nearest hospital to a Level 1 stroke center that can successfully treat them jeopardizes their chance at a full recovery. Nearly two million brain cells are dying every minute as the stroke prevents blood flow to the patient’s brain, depriving it of oxygen.

In 2017 alone, 3,555 Virginians died from a stroke. We must do more to improve our state’s system of care to ensure more patients can survive and thrive following a stroke.

Virginia took an important step in 2018 when the General Assembly passed legislation authorizing the Virginia Department of Health to establish a process to ensure the quality and efficient delivery of stroke care statewide, along with facilitating data collection and information sharing among hospitals and health care providers. Separate legislation that also passed established a system of designated stroke centers. I also want to thank the General Assembly for the resolution it passed earlier this year recognizing the efforts of Get Ahead of Stroke, headquartered in Virginia, to improve outcomes for stroke patients nationwide.

We need to build on this progress by making sure patients afflicted with the deadliest form of stroke are transported directly to Level 1 stroke centers. It’s a process that already exists for trauma patients in which first responders take critically injured patients directly to Level 1 trauma centers for the life-saving treatments they need to survive. Why should there be different standards for stroke patients?

Only Level 1 stroke centers can efficiently and effectively provide the multifaceted neuroendovascular care that severe stroke patients need to survive and then thrive. But, we need to make sure the appropriate emergency triage and transportation protocols are in place to ensure these patients get to the right place at the right time. Virginia has several neuroendovascular-ready facilities across the state, including Carilion Clinic Roanoke Memorial Hospital, Riverside Regional Medical Center, Inova Alexandria Hospital, Inova Fairfax Hospital, Virginia Hospital Center, UVA Health, VCU Health, HCA Virginia and Sentara Northern Virginia Medical Center, to name a few.

Ultimately, it all comes down to time. Every minute of delay before stroke patients receive the care they need reduces their chance at a full recovery. Severe stroke patients who undergo neuroendovascular stroke surgery experience an increase in their life expectancy by five years when compared to patients who do not receive this care.

What can you do to help? I hope you will join me in observing World Stroke Day on Oct. 29. This day allows us to speak in one voice to raise awareness of the unique needs and challenges stroke patients face around the world and here in Virginia. Share the wonderful resources and information found at with your loved ones, communities and elected officials. Urge policymakers to do what they can to help improve outcomes for stroke patients. Together, we can get ahead of stroke.

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Dr. Biraj M. Patel is a neurointerventional radiologist at the Carilion Clinic in Roanoke. He is a senior member of the Society of NeuroInterventional Surgery (SNIS), based in Fairfax. SNIS’ Get Ahead of Stroke is a national public education and advocacy campaign designed to improve systems of care for stroke patients. Contact him at:

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