Australian Stroke Alliance Showcase Document

Delivering urgent stroke care on the roads and in the air.

Co-chief investigators Professors Geoffrey Donnan and Stephen Davis austrokealliance.org.au @AusStroke

Delivering urgent stroke care on the roads and in the air.

The Australian Stroke Alliance’s program brings together over 30 national agencies committed to transforming pre-hospital stroke care. Our unique collaboration integrates clinical, academic, scientific, paramedical, consumer, commercial and philanthropic partners. This is a once-in-a-generation opportunity to address an unmet clinical need and to deliver urgent stroke care for all Australians.

INTRODUCTION When a person experiences a stroke, every minute counts. First responders know that intervention in the Stroke Golden Hour can make a lifetime’s difference as brain cells begin to die. Fortunately, improved medications and surgical interventions have transformed stroke care in Australia in the last 20 years.

We know that clot-busting drugs and surgical clot removal can stop the damage immediately – and the results can be quite extraordinary when delivered within the first few hours of the stroke.

A unique collaboration is now ready to intervene to transform the way stroke is treated. The opportunity can be compared to the revolution that took place in cardiac intervention – back when defibrillators and ECGs were placed in ambulances.

We know how to treat a stroke – but now we need to take the next step.

We are ready to drive a technological revolution so we can take essential scanning equipment to the patient – in an ambulance – by road or air. Only then will paramedics and doctors be able to see inside the brain and identify the type of stroke. And then a true transformation can take place. Life-saving medication can be administered there and then. The beauty of this proposal is the capacity to take life-saving stroke care across vast distances to regional and remote parts of Australia – for the first time. The potential for global health impact is enormous.

Lives will be saved. People will return to their productive lives.

Inequitable access to world-class healthcare will be overcome.

Delivering urgent stroke care on the roads and in the air.

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WHY ARE WE COMING TOGETHER?

Stroke is one of Australia’s leading causes of death and disability incurring an annual financial cost of $5bn1 and a loss of quality of life valued at $50bn.1 › Stroke is one of Australia’s biggest killers and a leading cause of disability 2 › There is a stroke every nine minutes in Australia (about 60,000 annually), and 12,000 people die › By 2050 this number will increase to one stroke every four minutes (132,500 annually) and significantly, there are expected to be one million stroke survivors1 › 65% of stroke survivors suffer a disability which impedes their ability to carry out daily living activities unassisted › Around 30% of stroke survivors are of working age (under the age of 65)2 › The overall financial and wellbeing impact of stroke upon Australian society is estimated at $54B p.a.1 › The incidence of stroke is projected to increase significantly with population growth and an ageing population › By 2050, an estimated one million Australians will be affected by the effects of stroke if we do not grasp this opportunity.

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Delivering urgent stroke care on the roads and in the air.

“With many of our Alliance partners we have made a huge step forward with the introduction of Australia’s first Mobile Stroke Unit. We look forward to using the knowledge we gained through this exciting and successful collaboration to further innovate and see the benefits of this and other innovations extended to all Australians no matter where they live.”

– Adjunct Associate Professor Mick Stephenson, MICA paramedic and ED of Clinical Operations at Ambulance Victoria.

Treatment is time-critical.

Current access to early treatment is poor, particularly in regional and remote Australia. › One-third of Australians live in rural and remote locations. They are 19 percent more likely to have a stroke than urban dwellers3. Regional and rural Australians are also more likely to die or be left with significant disability as a result of stroke, due to limited access to best-practice stroke treatment and care › Only 53 percent of regional hospitals offer clot-busting medication as an acute stroke treatment 24/7, compared with 83 percent of metropolitan hospitals3 › Only three percent of rural and remote stroke patients are treated in a stroke unit compared to 77 percent of metropolitan patients3 › Stroke is a time-critical medical emergency where time saved equals brain saved. There is a clear chain of survival, and we know that fast care will reduce the likelihood of lifelong disability › Advances in stroke treatment, many of them led by Australian researchers, mean stroke can be treated and patients can make a full recovery, if they can access emergency treatment in time › Air Stroke Ambulances need to be able to offer sophisticated stroke diagnosis as a critical step in narrowing the urban, rural and Indigenous healthcare gap › The greatest opportunity to improve outcomes is in the first ‘Stroke Golden Hour’ after onset.

1. “The economic impact of stroke in Australia” – Deloitte Access Economics (2013).

2. Australian Institute of Health and Welfare 2018. Australia’s Health 2018.

3. Stroke Foundation 2017 National Stroke Audit.

Delivering urgent stroke care on the roads and in the air.

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WHY THE STROKE GOLDEN HOUR? Australian researchers are world leaders in stroke, working within a unique geographical landscape. The potential is enormous.

Advances in brain imaging, breakthrough clot removal medications, and surgery have opened the time-critical window for treatment. All Australians, regardless of postcode, should have access to emergency treatment within the Stroke Golden Hour. Urgent brain scanning is essential to ensure fast treatment.

As the home to the world’s most extensive aeromedical retrieval system, the Royal Flying Doctor Service, and a sophisticated road ambulance service, we have an opportunity to dramatically improve the nation’s response to stroke.

An alliance of 30 Australian organisations is set to transform life-saving stroke care by taking pre-hospital care to the patient. It’s about world-first innovation.

It will save lives. It addresses inequity.

It is brilliant for its capacity to generate wealth for the nation.

The Australian Stroke Alliance’s key technological advances will radically transform pre-hospital treatment, improving patient outcomes. › Brain imaging: Design and build new, ultra-lightweight and low-cost brain

imaging technologies. These are fundamental to enable on-scene diagnosis and urgent treatment › Stroke Air Ambulance: Develop the world’s first Stroke Air Ambulance

(helicopter and fixed-wing) to deliver urgent pre-hospital stroke treatment to remote Australians › Stroke Capable Road Ambulance: Integrate ultra-lightweight imaging

technology within a standard ambulance to enable widespread delivery of pre-hospital stroke treatment across regional and rural settings › National digital telestroke platform: Informed by the new, portable imaging

and ambulance technologies, we will connect on-the-spot rural and remote paramedics and doctors to urban stroke physicians – for immediate diagnosis.

Professor Cees Bil and colleagues at RMIT’s aerospace design lab in the Faculty of Engineering.

The team is working with commercial partners to develop a portable brain scanner light enough to travel in a fixed wing plane or helicopter.

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Delivering urgent stroke care on the roads and in the air.

Bill suffered a stroke during the night and despite his wife’s fast action, Bill was in a remote location in Western Australia and treatment was tragically slow.

“If and how you live after stroke should not be determined by where you live. We all deserve the chance to survive and live well after stroke.”

– Bill Vernon, stroke survivor from rural WA.

When Bill suffered a stroke at 1.30am, his wife Denise called triple zero immediately.

He arrived at the local regional hospital by ambulance within 20 minutes. When they arrived, Denise asked the young doctor if he thought Bill had experienced a stroke. After a call to Perth, the doctor said he thought it was a stroke but because they couldn’t determine whether the stroke was caused by a clot or a bleed, hospital staff could not provide treatment. Bill was paralysed and in very poor shape. He was made comfortable and left in a dark room to wait for the morning when it was planned to transfer him to another hospital. Denise recalls the fear of not knowing if Bill would make it through the night.

In the morning Bill’s condition had not improved. The doctor arranged for him to be transported to Bunbury hospital, 45 minutes away. He was assessed, scanned and transferred to the Royal Perth Hospital.

In a devastating blow, Bill was told he would never be able to walk or talk again.

He was determined this would not be the case. He and Denise moved to Perth for a year so he could access the rehabilitation he needed. He worked incredibly hard on his rehabilitation and can now walk, but has trouble with his memory and finding words. Bill will never be able to return to work.

Delivering urgent stroke care on the roads and in the air.

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STROKE AND INDIGENOUS HEALTH

The Australian Stroke Alliance will work in partnership with Aboriginal and Torres Strait Islander communities.

“To understand the impact of stroke on Aboriginal and Torres Strait Islander people you need to look beyond the mortality and morbidity statistics. You need to understand the cultural impact. With stroke occurring a decade earlier in Aboriginal people, we are losing our next generation of Elders.

This Alliance is about more than improving stroke outcomes – it’s also about keeping our communities strong and our culture alive.”

Stroke disproportionately affects Aboriginal and Torres Strait Islander Australians.

Indigenous Australians have a stroke incidence rate that is 2–3 fold that of nonIndigenous Australians. › In the under 55 years population the stroke incidence rate is 6–9 fold › Indigenous Australians have higher rates of cardiovascular risk factors, are 10–30 years younger at stroke onset, and less likely to receive secondary prevention or access rehabilitation services › Their mortality rate from stroke is 3–5 fold that of non-Indigenous Australians.

Our Indigenous Research Advisory Council is co-chaired by two extraordinary doctors. › Dr Angela Dos Santos, is Australia’s first Aboriginal neurologist

and a Kweiamble and Gumbaynggirr Woman. She is based at the Royal Melbourne Hospital. › Associate Professor Luke Burchill is Australia’s first Aboriginal cardiologist,

and a member of the Yorta Yorta/Dja Wurrung nations. He will lead our Education platform and will continue his international research into adult congenital heart disease and heart failure.

Associate Professor Luke Burchill, Australia’s first Aboriginal cardiologist, and a member of the Yorta Yorta/Dja Wurrung nations.

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Delivering urgent stroke care on the roads and in the air.

A message from Professor Luke Burchill and Dr Angela Dos Santos

This initiative represents a once-in-a-lifetime opportunity to improve stroke care and outcomes for Aboriginal and Torres Strait Islander people. We plan to: › Deliver timely access to the right tests, the best expertise and the right treatment for stroke. This will translate to more Australian stroke survivors with less disability and longer healthier lives › Integrate a collaborative digital platform for stroke, supported by an Indigenous governance framework, that supports dialogue and knowledge exchange across communities, both Indigenous and non-Indigenous

“We are one of the richest countries in the world, with an incredible healthcare system. Yet, young Aboriginal and Torres Strait Islander patients who need to live on Country cannot access stroke care, which has the capacity to completely resolve stroke symptoms, as if the stroke was imagined.”

› Establish an evidence base to improve stroke outcomes by identifying where care is most needed › Exchange knowledge between Indigenous and non-Indigenous clinicians, researchers and community members to break down cultural barriers and increase our knowledge of Aboriginal and Torres Strait Islander peoples’ world views and understanding of stroke and stroke care › Improve risk screening and primary prevention by increasing awareness among Aboriginal and Torres Strait Islander people, communities and health services › Engage with Aboriginal and Torres Strait Islander communities, value Indigenous knowledge systems, and create space for Indigenous strengths-based solutions to improve stroke care and outcomes › Create a network to build training and capacity, supporting the next generation of Aboriginal and Torres Strait Islander researchers and community champions for stroke care and research › Develop culturally safe stroke care pathways for Aboriginal and Torres Strait Islander people that links them back to country and community for optimal care and healing.

– Dr Angela Dos Santos, Australia’s first Aboriginal neurologist and a Kweiamble and Gumbaynggirr Woman.

Delivering urgent stroke care on the roads and in the air.

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THE STROKE GOLDEN HOUR:

Delivering urgent stroke care to all Australians.

2021–2050

2021–2050

2021–2050

$50B

5-6 times

22k+

reduction “burden of disease”1

more stroke patients treated in the “Golden Hour”

stroke patients return to the workforce

2021–2050

56k+

patients with improved outcomes2

$15.6B Total economic benefit 2021–2050

$3.3B

of workforce productivity

$4.5B

of healthcare system productivity

$4.3B

of R&D and commercial impact

$3.5B

of new industry service model

1,700+

new jobs created through medtech and service delivery

A major financial investment will bring together over 30 national agencies committed to transforming pre-hospital stroke care for all Australians. Our unique collaboration integrates clinical, scientific, paramedical, consumer, commercial and philanthropic partners, in a once-in-a-generation opportunity to solve an urgent, unmet clinical need in Australia.

External economic evaluation (2020).

KEY BENEFITS Economic: Australian Stroke Alliance technologies will generate $15.6B in economic benefit between 2021–2050.

This world-first program to transform pre-hospital stroke care will generate $15.6B in economic benefit between 2021–2050. As well: › By improving health outcomes for stroke survivors, we will generate a $3.3B increase in workforce productivity and boost healthcare productivity by $4.5B › R&D and commercialisation activity by the Australian Stroke Alliance partners opens up a $4.3B global market opportunity for world-leading pre-hospital stroke care technologies › A new pre-hospital stroke care service delivery model will generate $3.5B of economic activity within Australia › Over 1,700 new jobs will be created across the MedTech R&D, manufacturing, and healthcare sectors.

Social: Australian Stroke Alliance technologies can reduce over 7,800 Disability Adjusted Life Years (DALYs3) each year, valued at $1.7B p.a.

“It would truly be such a game changer for Central Australian stroke management.

Our catchment area is huge (>1,000,000 km2) – from Elliot in the north, down to near Coober Pedy in the South, over into the Western desert regions of WA and over the border of Queensland… making distance and time major issues for timely stroke management.”

› By improving health-related quality of life, Australia will prevent 235,000 DALYs3.

One DALY can be thought of as one lost year of ‘healthy’ life, with the metric combining years of life lost due to premature mortality and ‘disability adjusted years’ lost due to disability › Avoidance of 235,000 DALYs3 generates a societal benefit valued at $50B4 by 2050 (based on Australian Government guidelines estimating the value of statistical life year at $182,000) › Up to six times more patients can be treated in the critical ‘golden hour’ after stroke onset › Pre-hospital stroke care will deliver improved patient outcomes3 for 56,000 patients with over 22,000 additional patients able to return to the workforce › An Air Stroke Ambulance capability is a critical step in narrowing the healthcare gap for remote and Indigenous Australians who experience stroke 10 years earlier than non-Indigenous populations › Every year 1,200 DALYs3 can be avoided for remote Australians who have limited access to golden-hour stroke care.

3. D ALYs refers to Disability Adjusted Life Years which represent the number of years of “healthy” life lost.

4. S ocietal benefit is valued by apply the Value of a Statistical Life Year (based on Australian Government guidelines) to the number of DALYs avoided.

– Dr Anna Holwell GP, Northern Territory.

Delivering urgent stroke care on the roads and in the air.

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TAKE OFF

Alice Springs

Jandakot Port Augusta Bendigo

Scale

Stroke unit providing thrombolysis and endovascular clot retrieval

Stroke unit providing thrombolysis only

Stroke unit without thrombolysis or endovascular clot retrieval

The Royal Flying Doctor Service reaches across vast distances as it serves rural and remote communities. Our CT brain scanners will be tested after being built into Pilatus PC-24 jets, taking pre-hospital care to the patient. We will be based in Jandakot (WA), Alice Springs (NT) and Port Augusta (SA). Bendigo will be used

by Ambulance Victoria as our helicopter test site.

THE AUSTRALIAN STROKE ALLIANCE Meet our members The Australian Stroke Alliance is led by internationally renowned neurologists and researchers, Professor Geoffrey Donnan AO and Professor Stephen Davis AM. Among their many achievements, both have chaired the World Stroke Organization and have pioneered life-saving treatments, transforming global stroke care over the last 20 years. They have built strong collaborations and these relationships are now coalescing to deliver an Australian first – the largest alliance of agencies ever assembled to deliver pre-hospital stroke treatment and education, driven by biomedical technological genius.

“We conduct extensive aeromedical retrieval for stroke from rural and remote Australia.

Many of our communities have high social economic disadvantage coupled with high chronic diseases, such as diabetes, hypertension, and renal disease, all of which contribute to stroke and reduce live expectancy.

The mobile CT will allow us to have a precise stroke diagnosis to enable treatment, thus saving lives.”

ESSENTIAL PARTNERS

DISRUPTIVE MEDICAL TECHNOLOGIES & NEW COMMERCIAL CAPACITY

C L I N I C A L T R I A L S A N D T R A N S L AT I O N

N E W H E A LT H S E R V I C E S A N D SY S T E M

N AT I O N A L D ATA C A P T U R E F R A M E W O R K

I N T E R N AT I O N A L C O L L A B O R AT I O N

NEW RESEARCH WORKFORCE CAPACITY

– Dr Fergus Gardiner, Royal Flying Doctor Service.

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“Clot dissolving treatment given to stroke patients with bleeding could be fatal. Urgent access to brain imaging is essential for treatment decisions as strokes caused by clotting or bleeding need vastly different treatment pathways. Because standard brain scanners are heavy, immobile and require purpose-built rooms, the future of scanning must be portable, and telehealth-enabled.”

– Professor Geoffrey Donnan, co-chief investigator.

“In three years of operation, Melbourne’s mobile stroke unit has treated ten times the number of patients within the ‘golden hour’, compared with a conventional hospital pathway. It has shaved-off an average of 41 minutes from diagnosis to treatment. Onboard is a neurologist, a radiographer, a paramedic, a MICA paramedic and a stroke nurse. It’s a game-changer. We know it works. Now it’s time to take the knowledge to the rest of the country.”

– Professor Stephen Davis, co-chief investigator.

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Delivering urgent stroke care on the roads and in the air.

THE ROAD AHEAD The Australian Stroke Alliance takes the hospital to the stroke patient and:

› Supports ground-breaking and innovative research to dramatically reduce the treatment times for stroke, extending existing knowledge and transforming stroke care in Australia and globally › Works in close partnership with Australia’s brightest academics and sharpest brain imaging technology companies to stimulate the creation of novel research programs and industries › Delivers a new healthcare model informed by consumers and supported by telehealth that will impact pre-hospital stroke treatment Australia-wide › Accelerates new technological advances in healthcare by developing three world-first lightweight, portable and affordable brain scanners designed by leading scientists and engineers from South Australia, Queensland and Victoria › Collaborates with ambulance services, hospitals, clinicians, consumers, philanthropists, health economists and commercial consultants to promote multi-disciplinary partnerships and approaches that enable transformative research and innovation.

Contact: Professor Stephen Davis AM, Co-chief investigator Professor Geoffrey Donnan AO, Co-chief investigator Dr Damien Easton, Chief Executive Officer Ms Amanda Place, Director of Communications, +61 411 204 526 Melbourne Brain Centre, Royal Melbourne Hospital Level 4 Centre 300 Grattan Street Parkville VIC 3052 Head office +61 3 9342 4405 @AusStroke Austrokealliance.org.au

We acknowledge the Traditional Custodians of Country throughout Australia and recognise their continuing connection to land, waters and sky. We pay our respects to their Elders past, present and emerging. We are committed to working together to address the health inequalities within our Aboriginal and Torres Strait Islander communities. The Uluru Statement from the Heart is a fundamental driver of our research, education program, and commitment to equity and access.