As one of the founding chairs of the Virginia Stroke Systems Task Force, he has helped bring together all the stakeholders in the state on acute stroke and rehab services, which helps hospitals, even small ones, develop as primary stroke centers.
"When I talk about organizing this in a hospital system, the most challenging and most rewarding is the orchestration of the ED services," he says. "They see everyone who is critical and if the staff isn't highly trained to notice subtle signs of stroke, they may take a victim who has more painful injury before they take a stroke victim."
That lost time counts in stroke more than anywhere else, simply because the symptoms can be so subtle, and damage from strokes can be minimized with early intervention.
"Once you recognize, the steps are protocol-driven just like trauma and MI (heart attack)," he says. "But that takes skill and training. Training takes time. And that's one thing they don't have a lot of, is time."
In a system full of large and small hospitals, the challenge, ultimately, is to bring all of them up to the speed of diagnosis of the big tertiary center. That's something on which Shephard spends a considerable amount of time and effort.