When Seconds Count: One Funder's Work to Improve Stroke Outcomes in Rural America

Photo: Johnny Adolphson/Shutterstock

Photo: Johnny Adolphson/Shutterstock

Residents of rural areas may love the peace and quiet, but when they need emergency medical care—say, for a stroke—all that wide open space may work against them: They're that much further from a hospital. Larger, more sparsely populated states can have a tough time maintaining advanced care centers sufficiently close to everyone, and philanthropic dollars can be hard to come by, as well.  

The Leona M. and Harry B. Helmsley Charitable Trust is one foundation that keeps the healthcare needs of rural communities in mind, particularly in the upper Midwest. A recent example is the three-year, $6.5 million grant out of its Rural Healthcare Program to the American Heart Association/American Stroke Association for the Mission: Lifeline Stroke initiative to expand and enhance stroke care in Nebraska. 

Mission: Lifeline Stroke will build upon the gains achieved by the existing Nebraska Stroke Advisory Council (NSAC), further strengthening the collaboration with stakeholders across the state representing hospitals, individual ambulance services, the Nebraska Department of Health, and others. The project will enhance many critical elements of an optimal stroke system of care, including: a system-wide data tool to assess protocols used throughout the continuum of care, coordination of treatment guidelines for EMS and hospital personnel, local plans for rapid transport of stroke patients, and more, including a public education campaign focused on recognition of stroke signs and symptoms and the need to activate the 911 system.

“This initiative represents a significant investment in Nebraska’s stroke system of care, especially in our rural areas,” said state senator Roy Baker. 

The Impact of Stroke: Deadlier for Rural Residents

Stroke is the fourth most prevalent cause of death in Nebraska, with more than 3,400 strokes annually accounting for nearly 800 deaths. Approximately 37,000 Nebraskans (3 percent) are living with stroke-related disabilities. The acute nature of heart attacks and strokes is particularly deadly and requires time-sensitive treatment to save lives and reduce lasting disability.

Every minute saved in heart attack and stroke treatment can directly improve survival and recovery rates. Under optimal circumstances, it can take an ambulance about seven to 10 minutes to reach the patient—but that time is often significantly longer for patients in rural areas. A few minutes may not sound like a lot of time, but for heart attacks or sudden cardiac arrest, time is muscle. When blood flow is restricted or shut off from the heart, the heart muscle dies. Mission: Lifeline saves lives by improving the system, saving valuable time, saving muscle and saving lives. Time to treatment in stroke is similarly critical.

In Nebraska, more than 40 percent of the population live in rural parts of the state. Rural residents are subject to many of the same health problems that urban dwellers are, but they also face some additional challenges related to living in rural areas. Rural areas are associated with a higher prevalence of stroke, as well as worse care and patient outcomes. Stroke is particularly deadly for rural residents, with mortality in rural areas as much as 30 percent higher than their urban counterparts. It is this disparity Mission: Lifeline Stroke seeks to change.

A History of Deep Investment In Rural Communities

This is the latest in a series of Helmsley investments in Mission: Lifeline’s system of care model for acute cardiac and stroke care. “We believe that a comprehensive approach is the best way to ‘move the needle,’ especially for rural populations that face longer transit times and limited access to specialists,” said Walter Panzirer, a trustee at Helmsley.

As we have reported, from 2010 through 2016, Helmsley has committed nearly $37 million in funding for Mission: Lifeline ST-elevation myocardial infarction (STEMI) projects in North Dakota, Wyoming, Minnesota, Nebraska, Iowa, Montana and South Dakota. In 2017, the first Mission: Lifeline Stroke project was awarded in North Dakota. With the recent award for the Mission: Lifeline Stroke project in Nebraska, the total Helmsley commitment to Mission: Lifeline projects through its Rural Healthcare Program is more than $46 million.


IP has followed Helmsley's investment in rural communities for years. We've written about a number of the trust's efforts to fund rural healthcare in areas like cancerdiabetes and heart disease, among others. Based in Sioux Falls, South Dakota, Helmsley’s Rural Healthcare Program made its first grant in 2010. The program supports innovative technology such as ePharmacy and eEmergency telemedicine, CT scanners, CPR devices, and treatment simulators, as well as initiatives for medically underserved areas in Montana, Wyoming, Iowa, Nebraska, North Dakota, South Dakota and Minnesota. Eight years after its beginning, Helmsley’s Rural Healthcare Program has surpassed a $300 million milestone in grants to improve rural healthcare across a seven-state region.

Helmsley chose to focus on the upper Midwest specifically for its gaps in healthcare access and relative lack of private funding.

While big names like the Ford Foundation, W.K. Kellogg Foundation and Robert Wood Johnson are longtime supporters of work in rural communities, the number of private and philanthropic funders who contribute heavily in rural areas is actually small. That’s changed somewhat, as we’ve reported, thanks to the proliferation of health conversion foundations and more awareness of the challenges facing rural residents. But grantmakers still have a long way to go in this regard.

Helmsley is setting an important example.

Related: Myths and Opportunities: What's Happening in Rural Philanthropy?