SHORTLY before noon on Friday 7 October, a 78-year-old man from Atid village near Odorheiu Secuiesc in Harghita County in central Romania, suffered a stroke at home. An ambulance was summoned that would take the patient to the nearest hospital.
On the morning this happened there was still only one hospital in Harghita County where stroke patients could receive acute treatment with thrombolysis to arrest the damage caused by stroke and give them a second chance at life. That hospital was however in the county capital Miercurea Ciuc, an hour and 42 minutes away.
Around midday on 7 October, Odorheiu Secuiesc Municipal Hospital was not yet a stroke-treating hospital. By 2.58 pm that afternoon they had become one. Exactly how this happened is a story that will be told over and over, because who doesn’t love a plot twist with a miracle ending?
A new pin on the map
The chief neurologist at Odorheiu Secuiesc Municipal Hospital is a leader who enjoys the trust and affection of his team. Dr Pelok Benedek had for some time been laying the groundwork for his hospital to start treating acute stroke. He provided training for nurses, attended stroke congresses, invited experts to share their knowledge with his team, and worked on the stroke protocol for his hospital.
Aware of the aspirations of the neurology team of Odorheiu Secuiesc, Angels consultant Mădălina Butuc provided them with Angels materials including checklists, a stroke bag and information about the FAST Heroes stroke awareness programme, and introduced them to Romania’s national stroke coordinator and stroke network coordinator, Professor Cristina Tiu.
“We are going to put another pin on the map,” they promised Professor Tiu. It would make Harghita County the third in the country to have more than one stroke- treating hospital.
A team that is also a community
As the summer drew to a close, plans took shape for simulation training at the start of October. It would be a two-day workshop dedicated to training, team-building and pathway simulation facilitated by doctors from nearby hospitals. Neurologist and stroke champion Dr Incze Emese came from Miercurea Ciuc to share her experience.
Dr Csilla Forró, emergency nurse Árpád Dorba and nurse Enikó Niţui from Sfântu Gheorghe in neighbouring Covasna County made an early start to reach Odorheiu Secuiesc in time.
Also present was Péter Szilárd, head of Harghita County Ambulance Service that in another two weeks would receive their first EMS Angels Award at a ceremony in Berlin.
Odoreheiu Secuiesc Municipal Hospital already had a number of things in its favour. They had mastered the basics of stroke; several younger doctors had been exposed to thrombolysis during their residency and, as new Angels consultant Bianca Pînzariu observed about her first experience in the field, “this team was truly a team”.
It took them just two minutes to complete a game in which they had to arrange themselves in alphabetical order without talking or breaking the line. Then they split into groups in which each participant, whether nurse, radiologist or porter, had to describe each other’s role.
“You could feel the warm atmosphere and the trust between them,” Bianca says.
"You had the sense this was a community."
Pathway roleplay
Friday morning started with a pathway walkthrough lead by Dr Emese whose hospital has treated over 160 patients with thrombolysis and holds two ESO Angels Awards.
In the roleplay simulation that followed, everyone played their parts with conviction – from the neurologist who got to experience the pathway from a patient’s point of view to the nurse who drew laughs with her theatrical performance as his concerned wife.
It felt “quite real”, Mădălina says, which injected the experience with some of the stress and adrenalin of a real-life case.
A simulated door-to-needle time of just 24 minutes put the team in high spirits for the debriefing. “When do we start treating?” someone wanted to know. “At 2 pm today,” Dr Pelok shot back. His joke drew another round of laughter. The time was 1 pm.
This is not a drill
Mădălina, Bianca and nurse Árpád Dorba were on their way home when a message pinged on Mădălina and Árpád’s phones at almost exactly the same time. The news was that Odorheiu Secuiesc Municipal Hospital had just thrombolysed its first patient.
Prenotification had come in at exactly 2pm. A suspected stroke patient from Atid village was on the way. The patient was already on the edge of the window for thrombolysis – Miercurea Ciuc was simply too far away.
The team who minutes earlier had been reviewing the morning’s events over a cup of coffee, mentally ran through the pathway they had rehearsed just two hours before. Dr Pelok was about to hand over his shift to Dr Zima Zoltán, but not a single person left the room. And when the ambulance arrived at 2.39 pm, they were ready.
The door-to-needle time was 19 minutes. And that is how, at shortly after 2.58 pm on Friday 7 October, Odorheiu Secuiesc Municipal Hospital in Harghita County put another pin on the map.
