Today, stroke care is provided in much the same way as trauma care was in the mid-1970s. About that time, surgeons realized that not all hospitals were equipped to treat victims of car crashes and other major accidents. So physicians led the effort to designate regional hospitals as specialized trauma centers and instructed paramedics to speed the most severely injured to those institutions. This change has saved lives and lessened disability.Now neurologists say that hospitals with the proper equipment and expertise should be designated as "stroke centers" to help ensure that patients receive optimal treatment. These centers would have a neurologist on duty or on call at all times and be equipped to perform and interpret three-dimensional brain images called computed tomography (CT) scans on all acute stroke patients within 45 minutes after they arrive. When stroke strikes, timing is everything. The powerful drug, called tissue plasminogen activator (tPA), greatly improves the chances of complete recovery in people who suffer a stroke in which a clot blocks the flow of blood to the brain. The drug, however, can be used to prevent stroke damage only if it is given within a few hours of the onset of the stroke. CT scans are critical because physicians must determine whether the patient is having a stroke caused by a blood clot before administering tPA. Clot-busting drugs would worsen the bleeding in an estimated 20 percent of strokes that are hemorrhagic (bleeding) strokes. In a one-year study of 6,876 stroke admissions at 98 hospitals ending in November '02, fewer than 5 percent of patients who were eligible for tPA received it. Among the reasons: Some go to a hospital unable to provide tPA while others simply ignore or fail to recognize the warning signs of stroke and don't seek emergency treatment until it is too late. Common symptoms include: • sudden numbness in the arm, leg or face on one or both sides of the body; • unexpected severe headache with no apparent cause; • sudden confusion, trouble speaking or comprehending; • sudden vision problems, dizziness and loss of balance or coordination. A Neighborhood Stroke Watch is needed to be sure every man, woman and child in the community knows the warning signs of stroke. When a dad's or mom's stroke occurs, neighbors can watch the kids and help rush the victim to the best-equipped stroke facility in case it is many miles away. If a 911 emergency vehicle arrives promptly, a family member should be available at the hospital to provide health information. One more tip: If you are at risk for a stroke and wish to be considered for tPA, carry a summary of your medical history in your wallet to help doctors verify your eligibility for the therapy. Some time ago, the Post wrote about Paul SerVaas' enthusiasm for providing cooling therapy for strokes. As a result, our own freezer is filled with ice blankets. Neighborhood Stroke Watch Needed • Does the city's emergency medical system transport patients with suspected strokes as rapidly as possible to the hospital? • Does the hospital have a Stroke Team led by a trained healthcare professional to evaluate the patient within 15 minutes of arrival? • Is the hospital lab open around the clock, seven days a week? • Does the hospital have a neurosurgeon available round the clock, seven days a week, to perform and interpret either a head CT scan or a brain MRI scan within 45 minutes of the stroke patient being admitted? • Does the hospital provide coordinate stroke care beyond the emergency department physician's evaluation? If not, is the hospital prepared to transfer the patient to a hospital that does? -- Brain Attack Coalition
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