Emergency Neurological Life Support: What to Do in the First Hour of a Neurological Emergency

Premier health institution The Medical City (TMC), in cooperation with Brain R.E.S.C.U.E. Philippines, a global partner of the Neurocritical Care Society of the United States, hosted the Emergency Neurologic Life Support (ENLS) Certification Course at the Augusto Barcelon Auditorium in Ortigas, Pasig  City on December 7 and 8, 2017.

ENLS is an educational program designed to help healthcare professionals improve patient care and outcomes during the critical first few hours of a neurological emergency.

Neurological emergencies such as coma, stroke, intracerebral hemorrhage, and ischemic stroke among others, arise frequently. In the Philippines, stroke is the second leading cause of death after diseases of the Cardiovascular System.

The first few hours during a neurologic emergency is indeed very critical. If not diagnosed and treated quickly, neurologic emergencies can have devastating results, with high rates of long-term disability and death. Prompt recognition is therefore an important skill. These are time-sensitive situations  where early recognition and effective treatment can mean the difference between life and death.

The focus of ENLS is centered on a standardized treatment algorithm, checklists to guide early patient care, and a structured format for the communication of findings and concerns to other healthcare professionals. ENLS was created upon the principle that efficient and appropriate in or out of hospital management of the early stages of a neurologic emergency, has substantial impact on patient outcome.

"The Department of Neurology celebrated 2017 Neurology Week highlighted by this ENLS course. We were joined by our partners --  Critical Care Medicine, Emergency Medicine and Neurosurgery. This joint project exemplified and embodied the collaborative, multi-specialty and inter-professional nature of services for emergency and critical conditions of the brain," said Dr. Jo Ann Soliven, TMC-ENLS Live Course Director and head of the Neurologic Emergency/Critical Care Services, TMC Department of Neurology.

The founders of the Brain R.E.S.C.U.E. (Organization) Philippines chose the TMC network of hospitals to be the ideal platform for the discussion and exposure to the emerging science of neurocritical care, putting into consideration TMC’s innovative visions and revolutionary approach to patient care.

The organization initially avoided an institution-based activity to send the message to healthcare providers that the focus is capability to deliver beyond institutions. It was later realized that it is best to show a concrete example of a provider-institution willing to learn and deliver.

"Quoting TMC’s Senior Vice President, Dr. Eugenio F. Ramos, ‘The course…is part of TMC’s contribution and commitment to advance neurocritical care in the country. What a grand way to end 2017 and prepare our Neuroscience and Acute and  Critical Care services for 2018.’ This is just the beginning of TMC’s progress towards ensuring  quality emergency care for the brain injured patients," said Dr. Marian Vita Nova C. Sodusta, TMC intensivist, Acute Stroke Unit/Neurology Intensive care Unit, and member of the TMC-ENLS team.

A total of 322 doctors, nurses, and other allied healthcare professionals attended the two-day symposium. The doctors came from various specialties − Neurology, Neuro Surgery, Internal Medicine, Cardiology, Nephrology, Pulmonology, Radiology, Emergency Medicine and Critical Care. About 30 percent of the attendees were from TMC network sites namely TMC Main, TMC Iloilo, TMC Pangasinan, TMC South Luzon, TMC Clark and TMC Clinics, while the rest came from other hospitals in Metro Manila and in the provinces. One attendee came from as far as Cambodia.

The ENLS has 14 modules --  Acute Ischemic Stroke, Acute Non-traumatic Weakness, Airway, Ventilation, and Sedation, Approach to the Patient with Coma, Intracerebral Hemorrhage, Intracranial Hypertension and Herniation, Meningitis and Encephalitis, Pharmacotherapy, Resuscitation Following Cardiac Arrest, Subarachnoid Hemorrhage, Spinal Cord Compression, Status Epilepticus, Traumatic Brain Injury, and Traumatic Spine Injury, capped by two special lectures on Targeted Temperature Management (TTM) in neurocritical care and Neuro ICU establishment.

Two international speakers, Dr. Romergryko Geocadin and Dr. Jose I. Suarez., were part of the faculty.

Dr. Geocadin is a past president of the Neurocritical Care Society (NCS) and professor in the Department of Anesthesiology-Critical Care Medicine, Department of Neurology, and Department of Neurosurgery of the Johns Hopkins University School of Medicine (Maryland, U.S.A.).

Dr. Suarez is NCS vice president, professor of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, and director of the Neurocritical Care Division at the Johns Hopkins University (Maryland, U.S.A.).

"Officially you are hosting the biggest ENLS course in history," said Becca Stickney, Director of Education of NCS.

Initially, the TMC-ENLS team led by Dr. Soliven wanted to empower the healthcare professionals from the TMC network sites and to ensure that they are capable of handling neurological emergencies.

Dr. Soliven said the team, however, decided to extend the invitation to the different regions of the country to make it a nationwide learning experience.

Healthcare professionals from as far as Ilocos, Cagayan and Isabela in far north Luzon to Iloilo and Bohol in Visayas and to Sultan Kudarat and Zamboanga City in far south Mindanao took advantage of the invitation and are now ENLS certified.

"We have once again proven that we are a country always eager to learn and progress. A gift of the Neurocritical Care Society (NCS) to global neurological science, let us maximize what ENLS has to offer," said Dr. Soliven in her message to the ENLS course participants.

"Our success does not end in your learnings. It shall only begin when you go back to your places of practice to change the chances of survival and recovery of your patients," added Dr. Soliven.

Doctors, nurses, and other healthcare staff from small hospitals in the provinces learned during the ENLS course that there are simple things they can do before transporting patients with neurologic emergencies to big hospitals. They can also start creating protocols for efficient and appropriate management of patients during the first few hours of a neurologic emergency.

With the success of the recently held ENLS course at TMC Main, the TMC-ENLS team plans to hold another certification course next year in Iloilo to reach out to more healthcare professionals and  to upgrade neurologic emergency and neurocritical care in the Philippines.

For more information about ENLS, you may call the Department of Neurology at 9881000 ext. 6270.