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A Meeting Of Minds In Greece

April 2023 marks one year since the Angels Initiative received a warm welcome from the stroke community in Greece. A landmark meeting that took place around the halfway mark gave impetus to the advancement of stroke care quality in Europe’s second-oldest population.
Angels team 15 March 2023


Meetings tend to get a bad rap. People complain that there are too many, they’re too long, and they get in the way of productivity. But meetings can also be a critical tool to get everyone on the same page – and the right meeting at the right time can result in a breakthrough with the potential to impact thousands of lives.

A meeting of this stature took place on Friday 11 November 2022 in the northern Greek city of Thessaloniki. Present were around twenty neurologists from major hospitals across the country, and the national director of EMS. In the chair was Dr Georgios Tsivgoulis of University Hospital Attikon who is also the national stroke coordinator for Greece and vice-president of the European Stroke Organisation. On the podium was Eleni Panoutsopoulou who just seven months earlier had become the first-ever Angels consultant in Greece.

Eleni introduced the Angels Initiative and explained how the five platforms in the Angels model can help Greek hospitals improve their stroke care as it has countless hospitals elsewhere. She provided information on the ESO Angels Awards and the EMS Angels Awards, an overview of stroke care in Greece, and a summary of Angels activities to date including hospital visits and the participation of Greek physicians in an Angels train-the-trainer event and simulation workshops in Kaunas, Lithuania.

Training and simulation was one of three discussion topics on the agenda, along with arrangements for an Angels Day that will take place in September, and the importance of capturing stroke treatment data for quality monitoring, which lead to a vigorous exchange of views.

Greek hospitals are doing a lot of things right, says Eleni, who credits Dr Tsivgoulis with the warm welcome she and Angels have received from the stroke community in Greece. “There has been a lot of progress in treatment with thrombolysis and the default position at stroke-ready hospitals is to treat acute stroke if the patient is eligible. So it’s not a question of not treating, but how fast.”

The median door-to-needle time in Greece is 63 minutes, so her initial focus will be on standardising procedure in existing stroke centres and eliminating treatment delays.

There is no shortage of challenges. Greece has the second oldest population in Europe after Italy, and therefore a large cohort that is vulnerable to stroke. The quality of care differs sharply between Attica, where almost half the population lives, and remote villages both on the central mainland and smaller islands.

Policy dictates that a state ambulance will take you to the nearest on-duty public hospital irrespective of their stroke-readiness, and in small villages the pathway to the nearest hospital goes via the local Health Centre, with the potential for further delay.


On the bright side, the national EMS director is enthusiastic about improving stroke care through training and awareness, and Greece is already the cradle of an award-winning educational programme aimed at raising awareness of stroke symptoms and the need for speedy action.

Just 13 km north of the Hyatt Regency Hotel where the 10th Hellenic National Stroke Conference provided the ideal setting for the first Angels steering committee meeting, lies the University of Macedonia where Prof Harriet Proios and Dr Kaliope Tsakpounidou of the Department of Education and Social Policy collaborated with Angels project lead Jan van der Merwe to create the Fast Heroes campaign.

The campaign, which leverages children’s enthusiasm for learning and sharing to spread knowledge to the rest of their family, particularly to their grandparents, was piloted in Greek schools before being introduced to other countries and continents.

Fast Heroes remains popular among Greek students and teachers, Eleni says, with more classrooms signing up to save the world, one grandparent at a time.

The meeting in Thessaloniki provided great momentum to the Angels project in Greece, forecasting successful outcomes for an intervention dedicated to saving stroke patients’ lives and futures.

In the words of Canadian author Nadia Scrieva, “Each meeting occurs at the precise moment for which it was meant. Usually, when it will have the greatest impact on our lives.”

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