A third of stroke victims delay action by avoiding ambulanceA new study says many stroke victims lose valuable time by not taking an ambulance to the hospital.
By: John Lundy, Duluth News Tribune
When a stroke occurs, every minute counts.
“The studies have been very, very clear that the sooner we give this treatment … the better chance we have of a very good outcome,” said Gail Wallace, a nurse practitioner in the neurology department at Essentia Health-St. Mary’s Medical Center.
“In stroke, that might mean the difference between being able to return home or having to go to the nursing home.”
But more than a third of stroke victims in the United States don’t get to the hospital by ambulance, says a study published today in the journal “Circulation: Cardiovascular Quality and Outcomes.” The journal is published by the American Heart Association.
“Our problem here in the Northland is we’ve got some tough folks,” Wallace said. “They want to wait and see how it is tomorrow. They want to call their daughter in Albuquerque. They don’t want the neighbors to know, so sometimes they won’t call an ambulance because then everybody will know.”
Stroke is the fourth-leading cause of death in the United States, according to the Centers for Disease Control and Prevention. It’s also a leading cause of long-term disability. The annual cost in terms of health-care services, medications and missed days of work is an estimated $38.6 billion.
The research team, led by Dr. Jeffrey Saver of the UCLA comprehensive stroke center, studied records of more than 204,000 stroke patients arriving at emergency rooms at 1,563 hospitals from 2003 to 2010. Emergency medical services transported 63.7 percent of those patients to the hospital, the study found.
When patients were taken by ambulance, 79 percent of them got to the hospital within two hours after they first started to notice symptoms. That’s crucial, said Wallace, who has specialized in stroke treatment since the mid-1990s. The most common form of stroke can be treated in most cases with a clot-busting drug. But it must be injected within a maximum of 4½ hours from the onset of symptoms, and it’s better if injected within three hours, she said.
“That means a person has to have symptoms, recognize it, get into the hospital, be seen by us, get a CAT scan of the brain, IV started and a decision made, all within 180 minutes,” Wallace said.
The timing was close for Everett Huggins of Duluth when he suffered a stroke on Jan. 15.
Huggins, 25, had had heart surgery three times dating back to his mid-teens, but he admits he hadn’t been careful about taking his blood-thinning medication.
He was a Minnesota Department of Transportation employee installing a sign near McGregor about 12:30 p.m. on the 15th when bolts started falling out of his hand.
He didn’t know what was wrong, but his co-worker became concerned and gave him a ride to the sign shop at Midway Road and U.S. Highway 53. As Huggins continued to experience numbness, his supervisor called 911. Huggins rode with his supervisor to Kohl’s, where an ambulance met him.
Huggins said he doesn’t know if he received the clot-busting medication within three hours, but precious time had been lost. Even after he received the medicine, he had to be flown to St. Paul to have the clot surgically addressed.
He has fully recovered, Huggins said, and he’s taking his medication religiously. But if he ever experienced stroke symptoms again, he’d know what was happening and would call 911 right away.
The study showed that patients brought by ambulance are treated sooner, even after arrival. Almost 55 percent using emergency medical services had a brain scan within 25 minutes of hospital arrival, compared with just more than 35 percent who didn’t use EMS.
Part of the reason for that, Wallace said, is that EMS can advise the emergency room of a likely stroke, giving ER personnel time to prepare. A formalized “stroke code” arrangement was established between Gold Cross ambulance and local hospitals about a year ago to expedite those calls.