California counties improve stroke system

Seventy-five-year-old Leigh Weimers realized his left arm wasn’t working when he tried to pull his Costco card out of his back pocket. Luckily, he also had another card that helped him understand what was happening to him – one from the Stroke Awareness Foundation that he picked up at a Rotary Club meeting. Weimers realized his numb arm was a sign of a stroke, so he asked his wife to take him to the hospital.

The moment he walked into the Kaiser Permanente Santa Clara Medical Center and said he was having a stroke, the staff scanned his brain. They quickly realized Weimers was right. A pool of blood was building up in his head. They immediately started treatment.

Now, less than a year later, Weimers is completely recovered with no debilitating effects from the stroke.

In large part, his happy ending is due to the fact that he had his stroke in Santa Clara County-–the first in California to coordinate their stroke identification and treatment efforts.

Stroke is the leading cause of long-term disability in California and the third leading cause of death. Many gains have been made in the treatment of strokes in the past decade, with new methods of treatment and identification. But in order for treatment to save lives and prevent disability, it is crucial that patients get to a stroke center within three hours.

“Time is brain,” said Dr. Lilly Chaput of the California Department of Public Health (CDPH).

In order to improve stroke survival and lessen brain damage, CDPH is coordinating an effort to standardize stroke treatment in all 32 Emergency Medical Services (EMS) regions.

The first step towards a better stroke treatment system is to get hospitals stroke certified. This means that they have 24/7 access to some kind of imaging system like a CT scan or MRI to identify if a patient is having a stroke and what kind.

A stroke means your brain isn’t getting enough blood. For most strokes (87%) this happens when there is a clot in an artery (ischemic stroke). The less common type of stroke (hemorrhagic) happens when a blood vessel ruptures in your brain- as happened to Leigh Weimers.

A new drug called tissue plasminogen activator, or tPA, was released in the 1990s. If delivered within three hours of an ischemic stroke, tPA can bust a blood clot without invasive surgery, according to the FDA. Some hospitals have found that the drug can still be effective within a four-hour window.

“There is a new reason why you should call 911,” said Dr. Chaput.

She says it is always best to take an ambulance to the hospital when having a stroke. Treatment starts immediately, and first responders, who know which facilities are stroke certified, notify the hospital to prepare their imaging equipment.

Hospitals must also have treatments like tPA and specialists available in order to qualify as stroke centers. The first five Californian hospitals were stroke certified in Santa Clara County in 2004. Now 11 of California’s 32 EMS districts have stroke systems in place.

One of the challenges to improving state-wide stroke treatment is the difficulty for rural areas to meet the standards to become stroke certified, Dr. Lilly Chaput says. Many hospitals don’t have 24-hour access to a CT scanner, MRI or tPA.

CDPH is trying to help some of these districts to set up “telestroke” systems where they can connect a patient with a specialist via phone or video chat to determine the best treatment.

The other major challenge in rural areas is getting patients to a certified center within the three-hour time window. Chaput hopes that having statewide regulations will give the facilities helpful tools and guidelines.

Contra Costa was the most recent county to develop a stroke system, which went into affect January 2. Now seven of the nine hospitals in the county are stroke certified.

“We’re very lucky compared to other communities,” said Pat Frost, Director of Emergency Medical Services for Contra Costa Health Services. “We have hospitals in all of our regions so no patient is not near a stroke receiving center.”

Frost says it was easier for the county to coordinate a stroke system because they had already implemented a coordinated high-risk heart attack system. A primary delay for other EMS districts’ stroke systems, Chaput says, is that they are implementing a heart attack system first.

But the biggest challenge seems to be public awareness of stroke symptoms. “Nobody thinks it’s going to be them,” says Sherry Houston, Executive Director of the Stroke Awareness Foundation. But one in four people will suffer a stroke in their lifetime.

So the Stroke Awareness Foundation recently put forty thousand advertisements on buses in Santa Clara County to promote the ACT F.A.S.T (Face, Arm, Speech, Time) stroke identification system.

“If you’re the one having a stroke and your brain is under attack, how capable are you of diagnosing it?” Houston asks. “It’s people around you most likely that will notice.”

If you are the person assessing a friend or loved one’s stroke symptoms, first assess their face by asking them to smile. If one side of their face drops they may be having a stroke. Then ask them to raise their arms, if one drifts downwards they may be having a stroke. Then test their speech by asking them to repeat a sentence – if their speech is slurred they may be having a stroke. If they show any of these symptoms, call 911 and ask to be taken to a stroke center.

People are more likely to go to a hospital when having a heart attack than a stroke because of the crushing chest pains. “Stroke symptoms can be more mild and people think they should just lay down,” said Chaput.

If patients are treated within the three–hour window there is a good chance they won’t suffer any long-term disability, as was the case for Leigh Weimers.

With minimal physical therapy, such as practicing dealing cards and balancing, Weimers is back to normal. After semi-retiring from a career writing for the San Jose Mercury News, he is back to writing for various online publications. When he realized that he was ten years older then the first of the baby boomers he started his blog: Boomerometer, a barometer for Baby Boomers entering their golden years.

“I’ve even been able to go back to Costco,” Weimers says.

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