Massachusetts Health & Hospital Association

Strokes, Guns, a New Mental Health Resource

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> Improving Stroke Care
> Gun Violence
> MHA’s Spring Forward Leadership Summit
> Vaccines for Young Kids
> “Help is Here” Mental Health Resources
> CARe Forum Set for June 2


Bill Would Tackle All Aspects of Stroke Care in the Commonwealth

MHA-supported legislation now before the legislature would codify stroke care recommendations that a state-commissioned advisory group issued prior to the COVID-19 outbreak.

The Executive Office of Health and Human Services (EOHHS) created the Stroke Systems of Care Work Group in late summer of 2019 to analyze the state of stroke care in Massachusetts and make recommendations to improve access to treatment for large vessel occlusion strokes.

That work group recommended upgrading the field assessment tool that emergency medical service (EMS) personnel use to assess patients prior to arriving at a hospital, and supplementary training for EMTs and paramedics on use of the technology. It also recommended improved data collection by hospitals on discharge time for patients who present in their emergency departments but then are transferred to another site, as well as whether or not advance notice was made by EMS to the destination facility that a possible stroke patient was en route. But since only half of stroke patients arrive at a hospital by ambulance, the work group also stressed the need for a stroke awareness campaign for print, TV, and the internet to educate people about stroke symptoms and the need to seek help quickly.

A few months after the work group issued its recommendations, COVID-19 struck, causing the state and medical community to quickly shift their priorities and requiring the Department of Public Health (DPH) to pause work on implementing these new initiatives. Now that the pandemic has begun to abate, attention is once again being directed toward enhancing stroke care in the commonwealth.

Currently, nearly every hospital in Massachusetts possesses a Primary Stroke Services (PSS) designation, meaning the facility is able to provide emergency diagnostic and therapeutic services 24 hours-a-day, seven days-a-week to patients presenting with symptoms of stroke. Patients with large vessel occlusions – that is, more serious strokes that occur in an estimated 25-45% of patients – benefit greatly from facilities that can provide the advanced endovascular thrombectomy (EVT) treatment. EVT treatment is usually only available at large academic medical centers, and not all of these hospitals always have the number of neurointerventionalists on staff necessary to offer the treatment on a 24/7 basis. Currently, potential stroke patients that call 911 are transported through a “spoke-and-hub” process; that is, they are brought to the nearest PSS hospital and then, if needed, are transported to an advanced facility for EVT treatment.

EVT must be administered within 4.5 hours of a stroke, but many patients who have stroke symptoms cannot identify when they began, which means that oftentimes patients are transported to a facility that provides EVT but are unable to receive it because their “last known well” – the parlance used to describe the initial onset of stroke symptoms – is unknown. Other stroke patients who are brought to an EVT-capable facility do not have the kind of large vessel occlusions that are treated by EVT. And other “stroke” patients presenting in hospitals do not have strokes at all but may be suffering from, say, a severe migraine.

The MHA-supported bills in the state legislature – H2345, sponsored by Rep. John Lawn (D-Watertown) and S1396, filed by Sen. Brendan Crighton (D-Lynn) – direct DPH to follow the 2019 Work Group’s recommendations as intended. Specifically, DPH would develop regulations for improving the so-called FAST-ED stroke scale used by EMS personnel, improving training for EMS staff, and creating a public education campaign on stroke awareness to better be able to determine a patient’s last-known well, thereby improving timely access to EVT care. The bills also call for advanced data collection to help the state learn how long it takes to transfer a patient from an ED to a tertiary hospital, and how much time elapses between when a patient arrives at a hospital and when stroke treatment begins, among other data points.

The bills state that once DPH has the data in hand and strides have been made to improve the ability for EMS to determine stroke severity in the field it may, indeed, issue directives that perceived high vessel occlusion stroke patients should bypass the nearest PSS site and be transported directly to an EVT facility. This multi-pronged approach to improve public awareness of the signs of stroke so that patients seek treatment quickly and bolster pre-hospital stroke assessment and data collection to better ensure patients receive care at the appropriate site – as opposed to burdening an already understaffed EMS system by mandating direct transport to a handful of EVT facilities – is the goal of H2345 and S1396. The bills are currently before the Joint Committee on Public Health and under an extension order to allow the committee members continued time to review.

Harm Reduction Strategies Needed to Reduce Gun Violence

Another gruesome mass shooting – this one involving children – has once again focused attention on what society can do to stem the uniquely American phenomenon of gun violence.

Nineteen children, all fourth graders, and two teachers were murdered at Robb Elementary School in Uvalde, Texas last Tuesday. According to Education Week, which has tracked school shootings since the 2018 mass killing in Parkland, Florida, there have been 27 school shootings in the U.S. in 2022. The publication defines a shooting as gunfire on K-12 school grounds that killed or injured at least one person and does not include suicides. The Uvalde, Texas school shooting came 10 days after a self-professed white supremacist killed 10 Black people at a Buffalo, N.Y. supermarket.

The trauma inflicted upon the victims of gun violence and their families is unfathomable. The first-responder and medical communities who respond to mass casualty events – and who are often steeled against what they encounter – report that the situation is different when children are involved. Such terrible events have a lasting effect on caregivers.

As is often the case following such events, those who object to long-proposed gun control measures – limiting assault weapons, limiting magazine capacity, strengthening background checks or wait periods for licensing – point immediately to the mental health of the shooters. Numerous studies have shown that people with mental health issues are often the victims of violence, from robbery to sexual assault to murder. After a previous Texas school shooting – the 2018 murder of 10 students in an El Paso art class – the Texas governor mentioned the possibility of introducing “red flag” legislation that would allow state courts to take firearms away from a person who presents a danger to themselves or others. The Texas legislature did not hold a hearing on the proposal. In 2021, Texas passed a law that allowed Texans to carry handguns without a license or training.

“Make no mistake: this is a public health crisis. There is a way to move the needle on this issue,” said MHA President & CEO Steve Walsh, who expressed profound sadness about the Texas shooting. “We need to devote the same concepts of harm prevention and continuous improvement that we employ in healthcare to the public health issue of gun violence in America. It can be done.”

Walsh called attention to a New England Journal of Medicine April 2022 article by researchers at Boston Children’s Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health that called for the same federal commitment to reducing child deaths from gunfire as was devoted to reducing youth traffic accident deaths.

MHA’s Spring Forward Leadership Summit

More than 200 people showed up for MHA’s first in-person event since the pandemic began. The leadership summit featured a panel of healthcare executives (shown above), a deep dive into current happenings at the State House, and a panel featuring journalists covering the everchanging healthcare beat in the commonwealth. Much of the discussion throughout the day centered on the pressing issue of workforce. As Thomas Lee, M.D., chief medical officer at Press Ganey said during his presentation entitled Redefining Excellence in Times of Uncertainty, “We need our patients to trust us, we need our employees to trust us. They need to feel like our organizations will take care of them no matter what. You have to deserve trust, earn trust, and build trust.” On another panel entitled Cracking the Workforce Code, Rosemary Sheehan, chief human resources officer at Mass General Brigham, said, “We have to have an environment where people feel like they belong. Diversity isn’t enough – we need to create an environment where people can bring their entire selves to work.” Pictured in the photo above, from left to right, are moderator John McDonough, professor, Harvard T.H. Chan School of Public Health; Cain Hayes, president and CEO, Point32Health; Anne Klibanski, M.D., president and CEO, Mass General Brigham; Kevin Tabb, M.D., the president and CEO of Beth Israel Lahey Health; and Christine Schuster, president and CEO, Emerson Hospital.

Vaccines for Children 5 and Younger

Pfizer last week said that three doses of its COVID-19 vaccine in children aged 6 months to 5 years is 80.3% effective in battling the virus. Previous Pfizer tests of a two-dose regimen had mixed results. The Pfizer dose for the young age group is one-tenth that of the adult dose. The company said it would immediately apply for emergency use authorization with the Food and Drug Administration (FDA) and the FDA announced that it had scheduled a hearing on the Pfizer application, as well as a similar application from Moderna on June 15.

MHA Launches “Help is Here” Resources on Mental Health

As Mental Health Awareness Month draws to a close, MHA is releasing a set of communications materials that can help patients locate mental health resources. The “Help is Here” project allows audiences to view Massachusetts-specific hotlines, nonprofits, and education materials all in one place. It is also intended to complement MHA’s popular “Right Care, Right Place” campaign.

The “Help is Here” materials available for members’ use or adaptation include:

The materials have also been vetted by members of MHA’s behavioral health network and will be translated in the weeks ahead.

CARe Forum Takes Place Thursday, June 2

Part 2 of the 9th Annual Communication, Resolution & Apology (CARe) forum is taking place virtually this Thursday, June 2 from 9:30 a.m. to 12:30 p.m. Register here. Part 1 was held in October 2021 but is not a prerequisite to attending part 2.

The CARe model was initiated in 2012 by The Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI) initiated the CARe model in 2012 and this past March the Betsy Lehman Center for Patient Safety assumed responsibility for the program.

CARe guides provider organizations in promptly disclosing what is known about the harm event or unexpected outcome to patients and their families; investigating and better understanding the root causes of the event; sharing information with patients and families in a timely manner; and, in cases of preventable harm, offering patients and family members a sincere apology and financial restitution without litigation.

John LoDico, Editor