How in-ambulance care for stroke patients helps us save lives

Neurologist in Kankakee and Watseka, Illinois; Medical Director of Riverside Medical Center’s Primary Stroke Center

Time is critical when someone’s had a stroke. Care can’t wait until a patient arrives at our emergency department.

Area ambulance crews partner with us to learn how to recognize potential stroke symptoms and gather essential health information about patients while they’re on the road to us. These seconds or minutes may make all the difference in our ability to save a patient’s life.

If you think you are having a stroke, call 911 immediately.

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Riverside is a certified primary stroke center — the first of its kind in our area certified by DNV GL Healthcare. We see 400 to 600 stroke patients each year. Most of these patients can receive a medication called a tissue plasminogen activator, or tPA, that can potentially reverse a stroke. The key is we have to give this medication within three hours of a person having a stroke.

The average patient loses nearly 2 million neurons per minute  from the moment they have a stroke until they get treatment. A neuron is the basic working unit of the brain, a specialized cell designed to transmit information to other nerve cells, gland cells, or muscles. Once these neurons or brain cells are lost, they’re gone forever. That’s why our top priority for patients who have had a stroke is to get them help as soon as possible, including on their ambulance ride to the hospital.

Fast care with stroke treatment in ambulances

Historically, an ambulance is the fastest way for most people to get to the emergency room. But patients still were losing precious time during the trip to the hospital.

That wasn’t acceptable for us. We started training area ambulance crews in the south Chicago suburbs on the signs of a stroke and the medical information we need from the patient to start stroke treatment.

If paramedics and EMTs suspect that someone is having a stroke, they start gathering that person’s medical history as soon as they arrive at the scene. They let the family members know that we may need more information or consent to provide the tPA medication, so family members have to come along with the patient or must be available by cell phone for us to contact them. Because strokes can affect a patient’s ability to speak, the family’s help is crucial in this stage.

On the ride, the paramedics call ahead to alert Riverside’s emergency department doctors and stroke team that a stroke patient will be arriving soon. They conduct a physical exam, run tests for blood sugar and blood pressure levels, and start an IV to save valuable minutes in the emergency room.

Priority stroke care in the emergency room

Once the patient arrives in the emergency room, we perform a computed tomography (CT) scan to diagnose the type of stroke the patient is having. Our patients who have had a stroke are given priority access to get a CT scan as soon as they arrive. And unlike most hospitals, our radiology department is right next to the emergency department, so we can get the radiologist’s report in a matter of minutes.

The most common type of stroke is ischemic stroke, which often is caused by a blood clot that can come from the heart, the legs, or elsewhere in the body. Ischemic strokes account for about 87 percent of all strokes in the United States.

The tPA medication works by dissolving blood clots that are blocking blood flow to the brain. That’s why it’s commonly known as a “clot-buster.” There’s a slight risk — 6 percent — that the medication may cause bleeding, so we have to get consent from the patient or family before we use it.

This entire process is in place to get our patients the care they need as quickly as possible. The earlier we can give the tPA medication and break up the clot, the better chance a patient has to recover well from a stroke with little if any long-term effects or disability.

Our emergency room doctors are very well trained in this process. But we do sometimes have patients who have strokes when they’re in the hospital for another reason. When that happens, our stroke team rushes to the patient, immediately gets the information we need, and gives the tPA medication.

Recognize the warning signs of a stroke

Too many patients don’t get help immediately because they don’t realize they’ve had a stroke. Strokes often don’t cause pain like a heart attack or kidney stone. The symptoms can be more subtle and are easier to miss.

I recommend that patients and family members watch for FAST symptoms. FAST stands for:

  • Face – drooping on one side
  • Arm – drifting or drooping down of one arm or unable to hold the arms up
  • Speech – slurring or garbling of speech
  • Time – if you notice any of these signs, call 911 or get to the emergency room right away

Other potential signs of a stroke include:

  • Confusion or appearing disoriented
  • Numbness on one side of the body
  • Problems with balance or staggering
  • Sudden vision problems, including loss of vision in one eye or half of the vision in both eyes

People often ignore these warning signs. They may attribute them to other causes or think everything will be fine in a few hours. Butif it’s been more than three hours after stroke symptoms begin, we’re no longer able to give the tPA medication.

Minutes matter when it comes to stroke care. Don’t delay if your loved one could be having a stroke. The quicker you call 911 and get help, the more likely it is that the ambulance crew and our doctors will be able to save the patient’s life.