The race to convert the first Angels Region in Europe ended in a photo finish.
Reaching for the tape more or less simultaneously were two regions in Ukraine (Khmelnytskyi Raion and Kamianets-Podilskyi Raion), Savona in Italy, the Algarve in Portugal and Albacete in Castilla–La Mancha, Spain. But the highest platform on the podium belonged to Almería where the stroke community gathered on 30 October to celebrate this important milestone.
When at the start of 2024 Angels consultant for Andalusia, Susana Granados, joined the race to convert Europe’s first Angels Region, Almería looked like a strong contender. Torrecárdenas University Hospital in the capital city was already a champion. The two smaller hospitals, Hospital Universitario Poniente and Hospital La Inmaculada, had both attended Angels Days and were looking forward to working with her. And the region’s emergency service, the Centro De Emergencias Sanitarias (CES) 061 Almería, already had two EMS Angels Awards on their trophy wall.
But to reach her goal she would have to put in the hard yards. Both Poniente and La Inmaculada would have to reach at least gold status for the region to be in contention; and there were targets to reach for FAST Heroes implementation to ensure that Almería’s population would know what to do if someone had a stroke.
Converting an Angels Region means generating change on a grand scale, and getting hospitals, emergency services, local authorities and public educators to all work together to provide safe hands for stroke patients in their communities. It helps when there is a bright spot to light your way.
The bright spot spreads its light
Of all the bright spots in Almería there was one that shone brighter than all the others. In 2022 Torrecárdenas University Hospital had become the first diamond hospital in Andalusia and would go on to become the first hospital in Spain to achieve four consecutive ESO Angels Awards. The award put Almería on the national map, and marked a turning point for stroke care in the region.
“There was a before and after,” Susana says of this watershed moment. There was every chance that Torrecárdenas’s success could help unlock the potential in the rest of the province and score another first for Almería.
For her consultancies at Hospital Universitario Poniente and Hospital La Inmaculada Susana followed the same script – holding multi-disciplinary meetings, and enrolling them with RES-Q so they and she could analyze the pathway and evaluate their performance.
She recalls: “The simulation training at Hospital Poniente was my first simulation ever, and it went pretty well. Right away, we also agreed on plans to implement key priority actions and improve post-acute care at both hospitals.”
Hospital Inmaculada is situated in the north, which is the only part of the region not covered by the region’s EMS, the Centro De Emergencias Sanitarias (CES) 061 Almería. Primary care physicians attend patients in medicalized vehicles up to an imaginary line called km 21, where they are transferred into the care of the CES and transported to the hub.
Susana organized a training event involving doctors from Inmaculada, the CES and primary care, and laid the groundwork for implementing the RACE scale, which is a simple and rapid neurological scale to detect acute stroke patients with a high probability of having a large vessel occlusion.
A contamination of motivation
Because a stroke patient’s journey starts in the community, public awareness of stroke is the first link in the chain of survival. For Almería to become Europe’s first Angels Region, they therefore had to meet targets for implementing FAST Heroes – the award-winning stroke awareness campaign that has already educated over half a million children about stroke. In Almería, a pilot project undertaken some time before had not had much impact but Susana had a breakthrough when Joaquín García, the chief neurology nurse at Torrecárdenas University Hospital, had the brilliant idea of working with the school nurses.
After first securing the support of the ministers of health and education, they introduced the FAST Heroes a campaign to more than 50 school nurses, and by July the program had been implemented at 22 schools.
To get her hospitals over the line, Susana had a plan to consolidate her work in the region. She says, “It was important after working with each hospital separately to get them all together in order to create momentum. This opportunity came when the steering committee in the region invited me to help them organize their annual stroke day, which gave me access to
all the regional key opinion leaders at the same time, on the same day, in the same room.
“I introduced the Angels Region strategy, of course, and I would say there was a contamination of motivation especially when we talked about the Angels Awards. Of course all the hospitals wanted one and we talked about what the next steps could be; what we could do, and how we could help each other.”
A joyous celebration
The next time the stroke community of Almería met in the same room, was on 30 Oktober 2024, and this time it was for a celebration. The quarter two results had confirmed that Hospital Poniente had won a platinum award and La Inmaculada their first gold. Torrecárdenas collected another diamond, of course, and CES 061 Almería their third platinum award.
By working together towards the same goal, Almería had made sure that stroke patients in the region would have second chances.
This spirit of collective goodwill and shared purpose was evident at a gathering of everyone who had played a role in elevating Almería into an Angels Region. Taking turns behind the podium were Minister of Government of Almería, Ms Aránzazu Martín Moya, Minister of Education,
Mr Francisco Alonso Martínez, Regional coordinator of School Nurses, Ms Sonia Martínez Giménez, Minister of Health Mr Juan de la Cruz Belmonte Mena, regional stroke coordinator Dr Patricia Martínez Sánchez, and Regional Stroke Coordinator of CES 061, Gabriel Navarro Lorenzo.
The stroke coordinators from all three hospitals, Dr Salvador Maroto of Hospital de Poniente, Dr Mateo Silvente of La Inmaculada and Dr Antonio Arjona of Torrecárdenas, shared the stage, as did a stroke survivor, Mr Rogelio Manuel Parrilla Vargas, and an entire class of little heroes from the public rural school, Tres Villas in Nacimiento.
The award was of great importance, Ms Martín said. “It represents a recognition for which many regions across the continent and the rest of the world are working to become the first in Europe to achieve this level of collaboration.”
Since making history by becoming Europe’s first Angels Region, there has been more occasions to celebrate. Hospital Poniente and La Inmaculada have each won their second award, and Torrecárdenas has reeled in its eight diamond, showing the world that a community that works together, wins together.
