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Revved Up Stroke Response System Helps Calif. Man

SAN FRANCISCO -- Greg Moulton was getting ready for work one morning in 2006 when he suddenly lost all of the strength in his right arm, and he realized he was having a stroke.

Thinking fast, he called his wife and left a message for her. Then he called his office to let his boss know that he was having a stroke and "would be in shortly," Moulton said.

"I was very naive," said Moulton, 51, last week from his home in Fremont. "I knew what a stroke was, but I didn't know how serious it was."

Fortunately for Moulton, his wife did know, and so did the paramedics who arrived at his home a few minutes later.

Another lucky turn: Alameda County had just started a new emergency stroke response system, which meant that everyone from the 911 dispatcher Moulton's wife called to the emergency room doctors and nurses at the hospital where he was taken were ready for him and knew immediately how to treat him.

Such stroke systems have been popping up all over California in the past six years, and there are now 11 regions in the state - including Alameda, Contra Costa, Santa Clara and San Mateo counties in the Bay Area - that provide coordinated emergency stroke care. Contra Costa was the most recent county to start a system, which launched earlier this month.

"Stroke is very time-sensitive. Once you identify a patient, you want to get them to care as soon as possible," said Pat Frost, director of Contra Costa County emergency medical services. "We basically say within five minutes the brain starts to die without oxygen."

Third-Leading Killer
Strokes are the third-leading cause of death in the United States, and the main cause of long-term disability, according to the U.S. Centers for Disease Control and Prevention. About 795,000 people suffer a stroke every year.

Strokes occur when blood flow to part of the brain is interrupted by a clot or tear in an artery. The damage done to the brain can result in weakness on one side of the body, trouble with speech and vision, and cognitive problems.

If the stroke has been caused by a tear to the blood vessel, there isn't a lot of emergency treatment that can be done to reverse the damage. But most strokes are caused by clots that block blood flow, and in those cases, doctors can administer a drug to break down the clot.

That's why speed is the key to effective stroke treatment - the faster doctors can restore blood flow to the brain, the better their chances of preventing brain damage. There's a roughly four-hour window to give the clot-busting drug; after that, the damage is usually irreparable.

The problem is that many people aren't familiar with the symptoms of stroke and delay treatment, or else they suffer a stroke while they're asleep. The goal of the statewide emergency stroke systems is twofold: to educate the community at large about strokes and what symptoms to look for, and to coordinate treatment among emergency care providers.

"The key message is, if you recognize a stroke, call 911. The county is all revved up," said Dr. Jeffrey Klingman, a member of the American Heart Association East Bay Board, which helped create the stroke systems there, and chief of neurology at the Permanente Medical Group in Walnut Creek.

As part of the emergency stroke system, 911 dispatchers and paramedics are trained to identify possible stroke cases, looking for obvious signs like drooping on one side of the face, weakness on one side of the body and slurred speech.

Rushed to the Hospital
If a stroke is suspected, patients are taken straight to the nearest hospital with special stroke certification. It's similar to the counties' trauma systems, in which one or two hospitals are designated the go-to facilities to treat major injuries.

But in the case of stroke, there are usually many more hospitals designated to treat patients.

Once suspected stroke patients arrive at the hospital, they are quickly whisked away for a brain scan to confirm the stroke and to determine what kind of stroke they've had. Doctors and nurses interview patients and family members to find out how long the person has been symptomatic and if there's still time to administer drug treatment.

Meanwhile, the drug used to break up clots is already being prepared, so that it can be administered right away if the brain scan confirms that a clot is doing the damage. Ideally, patients will start receiving the drug within an hour, or even sooner, after arriving at the hospital.

"Once upon a time, maybe 15 years ago or less, when you had a stroke you got pushed into the back of the emergency room because there wasn't a lot to do for you," Klingman said.

Then the drug to break up clots was developed, and "suddenly we could do something very effective for treating stroke," he said. "But you have to do it properly, and it has to be given quickly."

Even for patients who can't receive the drug treatment, having coordinated care improves their long-term prognosis because they're being looked after by doctors and nurses who are trained and familiar with the complications associated with stroke, Klingman said.

Blood Vessel Tear
Moulton believes that's what helped him recover. His stroke was caused by a tear in a blood vessel, and therefore he couldn't receive drug therapy to reverse the damage. But getting to the hospital quickly meant that he had a brain scan right away, and the health care providers looking after him were prepared to treat dangerous symptoms that they might otherwise not have recognized.

His stroke left him with a permanent limp and numbness on the right side of his body, but he's able to walk and drive and speak, and he's grateful for that, he said.

"From the initial onset of my feeling the stroke to the time I was at the hospital was less than 45 minutes," Moulton said. "I've met many other stroke survivors, and a lot of them, it happened when they were asleep. They're a lot worse off than I am.

"I wouldn't do anything different, other than calling 911 first," he added with a laugh. "I'm so thankful I got to the hospital when I did."

Stroke symptoms There are several symptoms particular to stroke. If you are experiencing any of these symptoms, or see these symptoms in someone else, call 911 immediately.-- Drooping on one side of the face, especially when the person tries to smile. -- Pronounced weakness on one side of the body. -- When the person lifts both arms, one arm seems to drift down. -- Slurred speech. -- Some people experience a sharp, jabbing headache, but not everyone does. Source: National Stroke Association
 



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