According to the New York Department of Health, “About 6,000 people die from stroke in New York State every year.” While stroke-risk can increase with age, the past few years have shown an increase in strokes in people less than 65 years old. The faster a suspected stroke patient arrives at the hospital, the better his/her chances of recovery (optimum is under three hours from the FIRST signs/symptoms).
The chances of having to treat a stroke victim as an EMS provider is great, and knowing what to do for your patient can help minimize the permanent damage and possibly even save his life. Recognizing the signs is crucial. The public is being taught to use the mnemonic F.A.S.T. to check for Facial droop, Arm weakness, Speech difficulties, and Time to call 911. Not everybody who sees dear “Uncle Alvin” acting strangely makes the connection to stroke but thankfully is worried enough to call 911. In the professional EMS scenario, the “T” represents Time to get the patient to the hospital for lifesaving treatments.
Transient ischemic attacks (TIA) can resemble a stroke and are often referred to as “mini-strokes”; TIA and ischemic stroke both result from a disruption in blood flow to the central nervous system. TIAs are temporary and often resolve themselves within one to 24-hours leaving no permanent damage. However TIAs are often precursors to strokes and encouraging your patient to go to the ER where they can undergo a detailed neurologic exam and have an MRI or CT to find any lesions or carotid stenosis (which can warn of higher stroke risk) is important. If a person suffers a TIA, lifestyle and medical changes could be a factor in prevention of stroke.
Strokes can be Ischemic (blood clots in the brain) or hemorrhagic (bleeding in the brain); most strokes Ischemic, both can be life threatening. The faster that a patient can be treated with a clot-busting drug for an Ischemic stroke the better the outcome will be. If at all possible transport patients suspected with stroke to the nearest Stroke Center; NYS has designated a total of (as of January 2020) more than 100 hospitals across the state as Primary (acute ischemic stroke with IV t-PA and comprehensive supportive care), Comprehensive (subarachnoid intracerebral hemorrhage with neurosurgical services), and Thrombectomy Capable (large vessel occlusions with intracranial endovascular intervention) Stroke Centers.
During transport to the hospital it is crucial to monitor vitals and symptoms, ensure the airway, and obtain a comprehensive health history as well as all medications used. Give the patient oxygen as needed. Strokes will commonly leave a patient confused and disoriented, sometimes cause complete unconsciousness, dizziness, headaches and lack of coordination. Learning the patient’s health history, such as atrial fibrillation, blood pressure medications, blood thinners (including OTC like aspirin), and obviously if there has been a prior stroke of TIA is important; ask family if the patient is unable in any way to answer these questions.
Call ahead to the receiving hospital to inform them you are coming in with a suspected stroke patient, give current vitals, relevant health history and medications so that they can prepare proper protocols upon your arrival. With the proper notification, the time for a patient to be scanned and treated with rTPA (clot-buster) when indicated, treated for high blood-pressure, or whisked to the OR when necessary for bleeding control, the better chance your patient will have for survival and recuperation.
Remember that TIME IS BRAIN when dealing with a stroke victim.