‘Time is Brain’: Acute Stroke Care in the NWT

YELLOWKNIFE—Living in a city, we often take for granted the bountiful and diverse medical services that are available to us. In places like Edmonton, advanced medical facilities employing specialized services are feasible establishments because the population of our city and the surrounding communities demand it. The North, however, is a different story.

The Northwest Territories, for example, is described as having a ‘rural’ population. However, I think there is a distinction between someplace being ‘rural’ and being ‘remote’. Of the 40’000 people living in the NWT, 20’000 are located in the capital of Yellowknife. The other 20’000, with the exception of a few small towns, are communities that are often only accessible by ice-roads in the winter or bush planes in the summer. Red Deer is rural. Camrose is rural. Yellowknife is a rural. But Gameti, Deline, and Aklavik are remote.


(In this map of the Northwest Territories, note the absence of paved roads in most of the territory. Photo: graveltravel.ca).

Sadly, this remoteness often results in poor outcomes for anyone suffering from a medical emergency. Stroke, for instance, is a particularly challenging case due to the time-sensitive nature of its effective treatment. A common adage in stroke research is that ‘time is brain’. In other words, our nervous tissue is very bad at staying alive without oxygen and tends to die quickly, and as such it is necessary to restore oxygen to the brain as quickly as possible to mitigate permanent damage. In the NWT, the only place equipped to perform the appropriate therapies for stroke is Stanton Regional Hospital in Yellowknife. Moreover, these therapies must be administered within a four hour window in order to be safe and effective.

So, what happens if someone has a stroke in Gameti? Driving to Yellowknife on the ice-road (if it’s cold enough) is definitely off the table because that journey would certainly fall outside of the four hour window. Calling upon the territorial air-ambulance, or taking a private bush plane are other options but, again, the journey to Yellowknife would still put the patient hours and hours outside of the four hour window. The solution to this predicament: the patient is doomed to have a stroke. I’m not joking. The frustrating and tragic reality of the situation is that, currently, we cannot possibly administer therapeutic interventions to someone in Gameti suffering from an acute stroke within the necessary time constraints.

But there is hope! Recently approved stent-based treatments have been adopted in Edmonton that expand the four hour window to as much as twenty-four hours. While researching strokes in the NWT, part of my assignment has been to understand the feasibility of these new medical assets. While these therapies are promising, the issues preventing their adoption in the NWT are myriad: Problems with respect to transportation, communication, legislation, technology, and licensure stand in the way. Still, there is hope! The territorial healthcare system has just begun a radical reformation in how they operate as a system. I am optimistic that during these systemic renovations some of the roadblocks preventing acute care to those in need may be cleared away. Moreover, I am thrilled to be part of the movement advancing how acute stroke care is delivered in the NWT.

Liam Carroll

August 2018

Yellowknife, NWT.


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