Calif. County's stroke of genius?


Rebekah GordonInside Bay Area | | Tuesday, June 26, 2007

REDWOOD CITY, Calif. Stroke victims calling 9-1-1 in San Mateo County will more quickly get to the local hospital best equipped to help them, saving precious hours or minutes in getting to the treatment that can prevent permanent damage or death.

The stroke-care system, approved Tuesday

by the San Mateo County Board of Supervisors, will direct the county's Emergency Medical Services to take stroke victims to one of four designated hospitals with certified stroke centers.

"While strokes can cause death and disability, they can be treated to minimize disability -- or even, in many cases, eliminate (it) -- if the patient gets definitive treatment fast," said Barbara Pletz, the county's EMS administrator. "And by fast, we mean really fast."

The four hospitals are Kaiser Permanente Redwood City Medical Center, Peninsula Hospital in Burlingame, Seton Medical Center in Daly City and Stanford Hospital and Clinics.

Each received Primary Stroke Center Certification from the Joint Commission, a nonprofit that evaluates and accredits nearly 15,000 health care organizations and programs in the U.S. Commission certification is based on guidelines for care recommended by the American Stroke Association and the Brain Attack Coalition.

Stroke victims who have experienced their symptoms for 21/2 hours or less will be taken directly by ambulance to one of these four hospitals when 9-1-1 is called. Victims who have experienced their symptoms for three to eight hours will be taken directly to either Kaiser Permanente Redwood City or Stanford Hospital, which also are authorized to perform "additional invasive procedures that can save brain," Pletz said.

Kaiser Permanente South San Francisco Medical Center and Sequoia Hospital in Redwood City are in the process of pursuing accreditation to be added to the system. The county hospital, San Mateo Medical Center, is not planning to become certified.

The county Health Department has spent more than two years meeting with local hospitals to determine the feasibility of a stroke-care system. According to the department, San Mateo County is the only county in the Bay Area to adopt this two-tiered approach and one of just a few in the state to employ a stroke-care system at all.

"There's nothing, I don't think, in the history of my tenure on the board, that we'll do that will be more important," San Mateo County Supervisor Jerry Hill said of the stroke-care system just before it was approved. "We will make a decision that will save people's lives, directly, and it will improve the quality of those lives that we do save, in the long run."

Stroke is the third leading cause of death in the United States. Among survivors, it can cause significant disability, including paralysis.

A stroke occurs when blood supply to all or part of the brain is interrupted, leading to a rapid loss of brain function. Symptoms can include numbness or weakness of the face, arm or leg on one side of the body; vision problems; confusion or trouble speaking or understanding; difficulty walking or loss of balance or a sudden, severe headache.

Pletz said a community education campaign on how to recognize the symptoms of a stroke and when to call 9-1-1 also is forthcoming.

Bob Parsons, a stroke victim who is now an outreach advocate for the Stanford Stroke Center and the Stroke Awareness Foundation in San Jose, said victims or those around them can also play a part in bettering chances for a good outcome.

"If more people recognize strokes earlier -- either in themselves, or in loved ones, or in co-workers -- they might save their brains," Parsons said. "Time is everything in stroke. It is literally almost the only variable."

There are 20 accredited primary stroke centers in the Bay Area and 12 more hospitals in the process of becoming certified, Parsons said. There are 32 statewide.

According to the Joint Commission's Web site, neighboring Santa Clara County, which instituted a similar stroke-care system in 2005, has seven certified primary stroke centers.

Parsons emphasized that getting to a hospital best equipped to treat strokes is also key to a successful recovery. Critical hours can be lost going to a hospital less equipped for diagnosis and treatment, even if it's a closer drive.

"You've got to get to the right hospital," Parsons said. "It doesn't help to recognize symptoms and to be transported to a hospital that doesn't treat you."

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