# Brain Attack Coalition Symposium: Inequities in Access and Delivery of Acute Stroke Care

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The Inequities in Access and Delivery of Acute Stroke Care Symposium is a day and a half virtual event during which diverse teams of public health and stroke experts will share findings on equity issues, known and unknown causes or obstacles, and best practices or possible solutions concerning stroke care. The Symposium encourages the participation, feedback, and new ideas from interested stakeholders and providers in the broader stroke community.

The long-term goals of the symposium include improving stroke systems of care, providing more efficient and effective treatments, increasing equity in access and care, and improving outcomes for all affected populations.

## Methodology

A task force for each time epoch will share research and an assessment of the current landscape of the stroke care period according to 4 cross-cutting themes.

## Symposium Goals

Improve stroke systems of care during pre-hospital/EMS, hyper-acute/ER, and in-patient care timepoints, including elucidating more efficient and effective treatments, increasing equity in access and care, and improving outcomes for all affected populations. Written proceedings from this Symposium will feature identification of disparities and their root causes, solutions, and tangible actions.

### Agenda

#### March 17, 2022 - View Recording

#### March 18, 2022 - View Recordings

### Speakers

Dr. Ameer E. Hassan is a triple board-certified neurologist who specializes in Stroke, Neurocritical care and Endovascular Surgical Neuroradiology. Dr. Hassan is Head of the Neuroscience Department and a Professor of Neurology at the University of Texas Rio Grande Valley. He serves as the Director of Endovascular Surgical Neuroradiology and Clinical Neuroscience Research at the Valley Baptist Neuroscience Institute.

Dr. Hassan is known and recognized for his research in stroke, artificial intelligence, advanced imaging, antiplatelet use, advanced aneurysm and AVM treatment as well as the latest in intracranial stenting. He has published over 250 papers, abstracts and book chapters, and is currently the site Principal Investigator of eleven clinical trials and one of the Global Principal Investigators of the COMPLETE study and the LVO SYNCHRONISE study.

Dr. Hassan is the President of the Society of Vascular and Interventional Neurology (SVIN), a previous Chair of the American Academy of Neurology (AAN) Endovascular Section, previous chair of the South Texas Trauma Advisory Council – (Trac-V) Stroke Subcommittee. He is an active board member of the Society of Vascular and Interventional Neurology (SVIN), the American Heart/American Stroke Association – Southwest Affiliate, as well as the Brain Attack Coalition.

Dr. Southerland is a Harrison Distinguished Teaching Associate Professor of Neurology and Public Health Sciences at the University of Virginia. Dr. Southerland received his M.D. from the Brody School of Medicine at East Carolina University and completed neurology residency, vascular neurology fellowship, and a master of clinical science at the University of Virginia.  He is the past recipient of early career award from the American Heart Association/American Stroke Association (AHA/ASA) National Clinical Research Program and has served on the Leadership Committee of the AHA/ASA Stroke Council, as Past-Chair of the AHA/ASA Telestroke Committee, and on the writing committee for the 2018 and 2019 AHA/ASA Updated Guideline for the Early Management of Patients with Acute Ischemic Stroke. He serves as principal investigator or co-investigator for numerous stroke clinical trials with primary research interests focusing on addressing stroke disparities through novel applications of telemedicine and telestroke, innovative methods of prehospital stroke care, and augmented stroke diagnosis through machine learning. Dr. Southerland also serves as Executive Vice Chair and Residency Program Director for the UVA Department of Neurology.

Dr. Wira is an Associate Professor of Emergency Medicine at the Yale School of Medicine and also works clinically for the Yale Stroke Program.  He currently serves as volunteer Chair of the Emergency Neurovascular Care Committee of the AHA/ASA, and is on the Stroke Council Leadership Committee.  He has also served as Chair of the State of Connecticut Stroke Task Force.

David Satcher, MD, PhD is a physician-scientist and public health administrator with an extensive track record of leadership, research, and community engagement.  He is a Phi Beta Kappa graduate of Morehouse College and holds MD and PhD degrees from Case Western Reserve University, where he was also elected to Alpha Omega Alpha Honor Society.  Dr. Satcher served as the 16th Surgeon General of the United States (1998-2002) and the 10th Assistant Secretary for Health in the Department of Health and Human Services (1998-2001).  He also served as Director of the Centers for Disease Control and Prevention (CDC) and Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR).   Dr. Satcher has also held top leadership positions at the Charles R. Drew University for Medicine and Science, Meharry Medical College, and the Morehouse School of Medicine. He has received over 50 honorary degrees and has received numerous awards from diverse organizations and agencies. Currently, Dr. Satcher is the Founding Director and Senior Advisor for the Satcher Health Leadership Institute at the Morehouse School of Medicine, Atlanta, Georgia.

CDR Erika Odom (Commander, United States Public Health Service) is a senior epidemiologist in the Division for Heart Disease and Stroke Prevention at Centers for Disease Control and Prevention (CDC).  She received her PhD in Applied Developmental Sciences from the University of North Carolina at Chapel Hill in 2008 and completed a post-doctoral fellowship at the Frank Porter Graham Child Development Institute, conducting research on maternal mental health and the association with various developmental outcomes for young children.  CDR Odom joined the CDC in 2010 as an Epidemic Intelligence Service Officer where her work focused on promoting supportive environments for women who choose to breastfeed.  In her current position, she serves as subject matter expert on the pre-hospital environment and improving the stroke and cardiac chain of survival, while her research agenda focuses on medication adherence and psychosocial factors associated with cardiovascular health. CDR Odom has co-authored nearly 30 peer-reviewed publications and is committed to the advancement of public health science aimed at improving the health of vulnerable and medically underserved populations through excellence in research and programmatic development.

Karen Furie, MD, MPH is Chief of Neurology at Rhode Island Hospital, The Miriam Hospital and Bradley Hospital, and serves as Professor and Chair of the Department of Neurology at The Warren Alpert Medical School of Brown University and co-director of the Norman Prince Neurosciences Institute. She was the principal investigator of the NINDS P50 Partners Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) and the American Heart Association supported Harvard Bugher Center for Stroke Prevention and Genetics Research while at MGH. Dr. Furie has been involved in organizing and executing clinical trials dating back to the Trial or Org 10172 in acute stroke (TOAST). She was a co-investigator in the Enlimomab, CAPRIE, WARSS, VISP, WARCEF, MATCH, PRoFESS, and IRIS trials. In addition, Dr. Furie served as Chair of the NSDK and ANIE study sections, co-Chair of NST-1 and on the DSMB’s of WASID, SPS3, ARUBA, StrokeNet, CREST-2, and SIREN. Dr. Furie’s interest in biomarkers is broad.  She has studied vitamins and homocysteine, inflammatory biomarkers, markers of oxidative stress and coagulation, genetics/genomics, and multimodal imaging. She served as faculty in the NINDS Clinical Trials course, and early research career leadership courses run by the American Heart Association and American Neurological Association in partnership with NINDS and as a mentor in the TRANSCENDS (Training in Research for Academic Neurologists to Sustain Careers and Enhance the Numbers of Diverse Scholars) Scholars program funded by NIH. Dr. Furie is  past-Chair of Stroke Council and was Deputy Editor of the journal *Stroke.*She is currently the Editor-in-Chief of*JNNP**.*** She serves as a member of the AHA Council of Chairs, the AHA National Research Committee, and is Chair of the Stroke Council nominations committee. She is a member of the Brain Health Science Subcommittee.

Dr. Lawrence R. Wechsler joined the University of Pennsylvania in 2020 as Professor of Neurology at Perelman School of Medicine He was formerly Henry B. Higman Professor and Chair of the Department of Neurology at the University of Pittsburgh School of Medicine and Vice President for Telemedicine, UPMC. Dr. Wechsler developed and implemented the telemedicine program for acute stroke assessment at UPMC. Telemedicine has been implemented since 2006 in all UPMC system hospitals in order to provide access to acute stroke assessment and treatment by faculty of the UPMC Stroke Institute. Additionally, several other non-UPMC facilities now utilize telemedicine for stroke care. The vascular neurologists at UPMC provide 24/7/365 coverage via 2-way audio and video communication at community hospitals. Since the inception of the Telestroke service at UPMC, stroke patients have been evaluated with outcomes the same as expected for patients treated face-to-face. In addition to Telestroke, UPMC has expanded telemedicine to a number of specialty services lines across multiple locations and has active Teleconsult centers across several locations in Western Pennsylvania where patients can be scheduled to have a virtual visit with a specialist from Pittsburgh.

Dr. Wechsler received his A.B. from Harvard in biology and his M.D. from the University of Pennsylvania. He completed neurology residency and fellowship in cerebrovascular disease at Massachusetts General Hospital in Boston, MA. He holds memberships in several organizations, including the American Neurological Association, American Stroke Association, American Society of Neuroimaging and the American Academy of Neurology. Dr. Wechsler has authored and co-authored numerous articles related to stroke and stroke therapy. He participated as an investigator, steering committee member and advisor to multiple stroke trials and served on numerous committees for national organizations including the American Heart Association, American Academy of Neurology and the American Society of Neuroimaging. He was President of the American Society of Neuroimaging from 2009-2011 and Editor-in-chief of the journal Neuroimaging from 1998-2006. He is a fellow of the American Neurological Association, American Heart Association, American Academy of Neurology and American College of Physicians.

Dr. Mark J. Alberts is co-physician-in-chief of the Ayer Neuroscience Institute at Hartford HealthCare and Chief of Neurology at Hartford Hospital.

He earned his bachelor’s degree at Duke University, graduating magna cum laude, and his medical degree with AOA honors at Tufts University School of Medicine in Boston. He completed a medical-surgical internship at Newton-Wellesley Hospital in Newton, MA; a neurology residency at Duke Hospital in Durham, NC; and a NIH stroke fellowship at Duke. He is board-certified in neurology and vascular neurology.

Dr. Alberts is a nationally renowned physician leader, educator, researcher and healthcare executive with numerous academic accomplishments, and more than 250 scientific publications.  His clinical contributions have earned him national and international recognition and awards, including the Neurologist Pioneering Award from the Society of Vascular and Interventional Neuroradiology. He is well-known for helping develop national standards for hospitals to be designated as stroke centers.

His prior experience includes serving as vice chair of clinical affairs and hospital neurology at the University of Texas Southwestern Medical Center in Dallas and as medical director of neurology for the University of Texas Southwestern University Hospitals. He has held a variety of academic and leadership positions at Duke University Medical Center, Northwestern University Medical School, and Northwestern Memorial Hospital in Chicago. Among his many affiliations, he is a member of the Joint Commission’s Technical Advisory Council on Comprehensive Stroke Centers, a fellow of the American Heart Association, and Chair of the Brain Attack Coalition.  He is also a local principal investigator for the NINDS funded southern New England StrokeNet site (along with Yale University and Brown University) and local PI of the PCORI Funded C3Fit Study.  He has received grant support for research from NIH/NINDS, the Alzheimer’s Association, and the American Heart Association.  He has served and is a member of several NIH grant review committees and a reviewer for a number of national and international journals, including Stroke, JAMA-Neurology, and the Journal of Stroke and Cerebrovascular Disease.

Mary E. Jensen, MD, is Professor Emeritus in the Department of Radiology and Medical Imaging at the University of Virginia (UVA) in Charlottesville, VA.  She retired as a tenured Professor without term in 2021, having started as an Assistant Professor in 1991 and serving as the Director of the Interventional Neuroradiology (INR) section from 1998 to 2019.  She maintains a clinical appointment at UVA.

Dr. Jensen is a recognized leader in Neurointerventional Surgery, and has held several leadership positions in the Society of Neurointerventional Surgery (SNIS) from 2000 to 2016, including as the SNIS President and, later, as the first SNIS Foundation chair.  She has been the SNIS representative to the Brain Attack Coalition (BAC) since 2010, and is the current Chairperson of the FDA Neurological Devices panel.

Dr. Jensen’s expertise is in the use of minimally invasive treatments for neurological conditions such as brain aneurysms, embolic stroke, carotid artery disease, vascular head and neck tumors, intracranial vascular stenosis, brain arteriovenous malformations and fistulas, and vascular spinal disorders. In 1994, Dr. Jensen and her partner, Dr. Jacques Dion, performed the first percutaneous vertebroplasty in the US for the treatment of vertebral compression fractures, and went on to develop multiple techniques and tools for vertebral body augmentation.

Dr. Jensen has published over 125 peer-reviewed papers, presented more than 300 scientific papers and invited lectures, participated in multiple clinical trials and has trained numerous fellows who have gone on to practice at some of the top hospitals in the country.

Dr. Jensen is currently the President of Blue Ridge Area Interventional Neuroradiology (BRAIN) where she continues to provide INR services to patients in a private practice setting.

Prasanna Tadi, MD, is board-certified in vascular neurology and currently Stroke Fellowship Program Director at Geisinger health system. Dr. Tadi was trained at Brown University for his residency and at the University of Pittsburgh for his stroke fellowship program. Dr. Tadi also serves as the Director of Innovation and Fulfillment for Graduate Medical Education and Neurology Residency Associate Program Director. Dr. Tadi authored and co-authored many peer-reviewed scientific publications that have been published in some of the high-impact journals like stroke, Journal of the American Heart Association, European Stroke Journal, Neurology. He has been invited as a speaker, panelist, moderator for various national and international meetings. Dr. Tadi serves in various committees and sub-committees like Member of the Stroke Telestroke Committee and Member of the Stroke and Neuroscience community at American Heart Association. Apart from stroke, Dr. Tadi’s passion is to address physician burnout and develop studies and strategies to address physician burnout and promote wellness. Dr. Tadi got various grants for his work to address physician burnout. In 2016 he gave a TEDx talk at Brown University on happiness and wellness and developed a YouTube channel to discuss wellness content for healthcare professionals.

Dr. Richard Benson is Director of the Office of Global Health and Health Disparities (OGHHD) in the NINDS Division of Clinical Research. He is a leader in the fields of vascular neurology and health disparities research. His areas of research interest and expertise include: health disparities and health equity research, and minority, community, and global health. Dr. Benson has worked in the public and private sectors and is a volunteer with several professional organizations. He is a past president and current board member of the American Heart Association (AHA), Greater Washington Region (GWR). He was a member of the national AHA Stroke Council and is currently an American Academy of Neurology (AAN) Registries committee member. Dr. Benson received his B.S. in Chemistry from Fisk University, followed by an MD/PhD from Meharry Medical College in Neurophysiology (elected to AOA). Subsequently, he completed his neurology residency at the Harvard-Longwood neurology residency program in Boston, and a stroke fellowship at the Columbia University Neurological Institute in New York, while obtaining an M.S. in Epidemiology from the Mailman School of Public Health. After fellowship, Dr. Benson worked as a vascular neurologist in New York City at the Long Island Jewish Medical Center and St. Luke’s-Roosevelt Medical Centers. In 2005, he moved to the Washington D.C. area to work as a Program Director in what was then the Office of Minority Health and Research at the NINDS. He left the NIH in 2008 to focus on patient care, and in 2010 became Associate Medical Director of the NIH Stroke Program at Medstar Washington Hospital Center and Associate Professor of Clinical Neurology at Georgetown University Medical Center. Dr. Benson returned to the NINDS in 2019 to direct the OGHHD.

Dr. Martin-Schild graduated from the Tulane University School of Medicine, while also obtaining her PhD in Neuroscience. Dr. Martin-Schild completed a combined internal medicine and neurology residency at Tulane, followed by fellowship training in Vascular Neurology at the University of Texas Health Science Center in Houston, Texas. Dr. Martin-Schild founded and directed the Stroke Program at Tulane Medical Center 2008-2016, advancing to Primary Stroke Center level in less than 2 years and Comprehensive Stroke Center 3 years later.

Dr. Martin-Schild is the Statewide Stroke Medical Director for the Louisiana Emergency Response Network.  She is the President & CEO of Dr. Brain, Inc.  She currently serves as the Medical Director of Neurology & Stroke for New Orleans East Hospital and Touro Infirmary.  Dr. Martin-Schild’s research focuses on healthcare inequality and augmentation of rehab with neurostimulants and hyperbaric oxygen therapy.  She has over 100 published manuscripts.  Dr. Martin-Schild is a founding Board Member for Heart ‘n Hands, an organization dedicated to educating the next generation of New Orleans women about prevention and treatment of heart disease and stroke.  She also serves on the AHA Greater New Orleans Board of Directors, this year as its President.

Dr. Todd J. Crocco is a Professor in the Department of Emergency Medicine at the University of Maryland School of Medicine. Additionally, Dr. Crocco serves as the Vice President of Telehealth and Access Center for the University of Maryland Medical System. His passion for telemedicine is reflected by his previous experience as a tele-stroke provider and tele-ED provider.  Prior to joining the University of Maryland School of Medicine, Dr. Crocco also served as the chairman of the Department of Emergency Medicine at West Virginia University for 10 years.

On an academic level, Dr. Crocco has been devoted to studying the role of prehospital care systems in the treatment of stroke victims.  He has conducted several studies examining the feasibility of neuroprotective agent administration, neuroprotective agent development, new thrombolytic therapies, improving community awareness of the signs/symptoms/risk factors of stroke, as well as studying the knowledge base of EMS providers regarding stroke care.

Dr. Crocco has been an active educator of medical students, residents, and physician assistants.  He has won numerous awards for his teaching ability.  He is frequently invited to speak about stroke care at the regional, state, and national levels.

Walter J. Koroshetz, M.D., was selected Director of NINDS on June 11, 2015. Dr. Koroshetz joined NINDS in 2007 as Deputy Director, and he served as Acting Director from October 2014 through June 2015. As NINDS Director, Dr. Koroshetz directs program planning and budgeting, and oversees the scientific and administrative functions of the Institute. He has held leadership roles in many NIH and NINDS programs including the NIH’s Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, the NIHBlueprint for Neuroscience Research, the Traumatic Brain Injury Center collaborative effort between the NIH intramural program and the Uniformed Health Services University, and the establishment of the NIH Office of Emergency Care Research. Additionally, Dr. Koroshetz serves as Chair of the Interagency Pain Research Coordinating Committee (IPRCC) and the Executive Committee for the NIH Pain Consortium.

### Members

### Steering Committee Members

**Mark Alberts**, *(Co-Chair) Stroke Belt Consortium***Richard Benson**,*(Co-Chair) National Institute of Neurological Disorders and Stroke***Todd Crocco***, National Association of EMS Physicians***Lee Jensen**, *Society of NeuroInterventional Surgery***Gaurav Jindal***, American Society of Neuroradiology***Glenn Graham***, Veterans Affairs***Ameer Hassan***, Society of Vascular and Interventional Neurology***Becky A. Schierman***, American Academy of Neurology*

### Pre-Hospital Care Task Force Members

**Todd Crocco***, (Co-Lead) University of Maryland***Erika Odom***, (Co-Lead) Centers for Disease Control***Sheryl Martin-Schild***, New Orleans East Hospital, Louisiana***Ope Adeoye***, University of Cincinnati***Brendan Carr***, Thomas Jefferson University***Chris Richards***, National Association of EMS Physicians®***Ashish Panchal***, National Association of EMS Physicians®***Ed Jauch***, Mission Health***Todd Wagner***, Veterans Affairs***Nina Omeaku***, Centers for Disease Control***Sherita Chapman Smith***, University of Virginia***Andy Southerland***, University of Virginia***Charles (Chaz) Wira***, Yale Medical School***Rafael Rodriquez***, University of Puerto Rico; Neurosurgery***Stacey Quintero-Wolfe***, Wake Forest School of Medicine***Holly Ledyard***, University of Utah*

### Hyper or Acute Care Task Force Members

**Ameer Hassan***, (Co-Lead) University of Texas Health at San Antonio***Lee Jensen***, (Co-Lead) University of Virginia***Opeolu Adeoye***, University of Cincinnati Medical Center***Brendan Carr***, Mount Sinai Health System***Kevin Cockroft***, Penn State Hershey Medical Center***Siobhan Gilchrist***, Centers for Disease Control***Mahesh Jayaraman***, Brown University***Tracy Madsen***, Brown University***Sheryl Martin-Schild***, Louisiana Emergency Response Network/Touro Infirmary & New Orleans East Hospital***Eliza Miller***, Columbia University***Rafael Rodriguez-Mercado***, University of Puerto Rico-Medical Science Campus***Anjail Sharrief***, University of Texas Health McGovern Medical School***Andrew Southerland***, University of Virginia Health***Prasanna Tadi***, Creighton University***Charles Wira***, Yale University***Venu Vadlamudi***, Inova*

### In-Patient Care Task Force Members

**Larry Wechsler***, (Co-Lead) University of Pennsylvania***Karen Furie***,**(Co-Lead)**Lifespan/Brown University***Karen Albright**,*Upstate Medical University***Sandra Narayanan**, *University of Pittsburgh Medical Center***Sherita Chapman Smith**, *University of Virginia***Soojin Park**, *Columbia University***Prasanna Kumar Tadi**, *Creighton University***Babu Welch**, *University of Texas, Southwestern***Justin Caplan**, *Johns Hopkins University***Shadi Yaghi**, *Lifespan/Brown University***Michael Mullen**, *Temple University***Aaron Anderson**, *Emory university***Ryan Calabrese**, *National Institute of Neurological Disorders and Stroke***Nina Omeaku**, *Centers for Disease Control*

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> Post Event Summary
This day and a half virtual event brought together Brain Attack Coalition organizations and task force members with stakeholders and providers to share findings and identify opportunities for synergy in the identification of equity issues, their known and/or unknown causes or obstacles, and establishing best practices or possible solutions concerning stroke care across three time epochs. Session recordings are available using the links below:
- Day 1 - March 17, 2022
- Day 2 - March 18, 2022
- Read The Full Report  (pdf, 755 KB)
- Director's Message