Recently thrombolytic therapy for acute stroke patients is widely carried out and therefore neurological worsening is reduced with it. We experienced 4 cases of patients transferred from Tokyo islands to our institution after thrombolytic therapy. In one of these cases, clinical improvement　was recognized, although there was one case of hemorrhagic complication after thrombolytic therapy. Drip and ship method of rt-PA by helicopter transportation is safe and effective for the acute ischemic stroke patients. However it takes a lot of effort in order to perform the thrombolytic therapy at Tokyo islands medical facilities, we would like to cooperate with them.

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We, kozushima island clinic, and some mainland hospitals have developed good medical collaboration in the acute setting including emergency medicine. whereas, medical collaboration on the discharge support, when the patients returns to the island after recovery, is often insufficient. In the remote island, Nursing resources are limited. Now, we discuss that good medical collaboration on the discharge support is especially important with careful consideration about a situation of nursing requisition and limited nursing resources in the remote island.

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Here I introduce our social work support to hospitalized patients from the island. We start our support to patients and their families by consultation request from the beginning of acute phase treatment on admission. Many of the consultation are about changing hospital and associated problems about the case that the continuance of treatment, rehabilitation or medical care is required after discharge. Although some of the patients can discharge and return to the island, they cannot always take sufficient medical care there. Therefore we examine the policy depending on the situation of family and nursing care service at the island. Patients and their families may face to a variety of conflicts upon policy decisions, we do our support activities with fine-grained attention, receiving their upset feelings at each stage.

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