Dr. Kristen Seaman showed up early for her shift at St. Clair Hospital’s emergency department. She’d noticed a headache that morning but didn’t think much of it. As she was chatting with a fellow doctor in a treatment room, she suddenly realized her words were stuck. “I tried to say, ‘Lisa, I can’t talk!’ but nothing came out. It was terrifying.” The doctor immediately called a stroke alert, and staff rushed her to a CAT scan.
Dr. Seaman has a family history: her father died of a hemorrhagic stroke in his 50s; her own high blood pressure is controlled at 105/60. An MRI confirmed she had had two small strokes—a clot from somewhere had broken into two
—and she received tPA, the clot-busting drug that must be given within three to four hours of a stroke.
“I remember trying to rehearse ‘I love you’ over and over to say to my sons but still couldn’t get the words out until hours later,” she recalls. Luckily, Dr. Seaman made a full recovery, and eventually returned to her job at St. Clair, where she’s worked for 15 years.
“I remember thinking, ‘I’m 43! How is this possible?’” she says. But stroke can happen to anyone, at any age.
Stroke? Me? You may think of stroke as nothing an average, healthy person needs to worry about. But you’d be wrong, says Leslie Pope, nurse manager of the stroke unit at St. Clair Hospital. “Even children can have strokes.”
A stroke occurs when a vessel in the brain ruptures or is blocked by a clot, and brain cells deprived of oxygen-rich blood begin to die. When brain cells die, abilities you had a few moments ago are lost: memory, muscle control, vision, even the ability to speak.
There are two kinds of stroke: ischemic stroke—accounting for about 87 percent of all strokes—occurs when a blood vessel becomes blocked and oxygenated blood can’t get to the brain. The second type, hemorrhagic stroke, happens when a weakened blood vessel in the brain has ruptured.
A TIA or transient ischemic attack is often called a “mini-stroke,” but don’t be fooled by its short duration, sometimes seconds or a few minutes. A TIA and a full-blown ischemic stroke are both caused by the same thing: a clot of plaque, a fatty deposit of cholesterol, or other substances. Call 911 and take an ambulance to the hospital.
Just Call 911. Period. If you learn anything from reading this piece, the emergency medicine staff and stroke team at St. Clair Hospital would like it to be this:
If you think you might be having a stroke, call 911 and let an ambulance take you to the hospital. Do. Not. Drive.
“But why call an ambulance?” goes the reasoning. “They’re expensive, and I live minutes from the hospital.” Because seconds count in a suspected stroke. Because time lost means brain lost. Calling 911 and arriving at the hospital in an ambulance is the fastest and best way to get treatment during a stroke emergency.
Driving to the hospital is a common mistake people make, says Todd Pritchard, Chief at Medical Rescue Team South.
“The symptoms associated with a stroke can worsen in a short time, and possibly lead to a car accident,” he says. “Having a friend or family member drive is also a bad idea—if things worsen, all they can do is drive faster, which is not safe for anyone. Paramedics are prepared to deal with worsening situations.”
“You might think you’ll get to the hospital sooner than an ambulance can take you,” says Dr. Jason Biggs, chair of emergency medicine at St. Clair. But you’ll actually end up waiting longer.” Time is Brain.
St. Clair Hospital, a joint commission accredited primary center, sets up a cascade of extremely time-sensitive preparations for every suspected stroke patient arriving by ambulance, but it all begins with a call to 911.
Once the call is made, a highly-trained EMS crew already has been in touch with the hospital communications center, setting in motion the stroke team (including a CAT scan technician) expecting your arrival within minutes. In the meantime, EMTs assess your condition, symptoms and the all-important time of onset relaying key information to the hospital’s command post, while monitoring your vitals during the ride in.
The stroke team of a doctor, nurses and technicians is prepared and ready for your arrival, all-systems-go. No time wasted parking or waiting at the front desk. Because (say it with me) Time is Brain.
“This is a time-critical situation,” says Pritchard. “Call 911 immediately and let our paramedics provide assistance.”
Partnerships Pay Big Dividends
One of the linchpins of its stroke care program is St. Clair’s partnership with emergency medical service providers such as Medical Rescue Team South, (which responds to about 150 cardiovascular accident calls a year). “Our main goal is keeping the door to CT (CAT scan) time as brief as possible, says Venard Campbell, EMS supervisor at St. Clair. The hospital conducts regular training updates for all its EMS partners so the crew’s assessment skills remain second to none. The hospital also utilizes a telemedicine link-up (a real-time video connection) to neurological specialists at the Cleveland Clinic. “It gives us a very broad capability here. We can treat almost any kind of stroke,” says Dr. Biggs.
When a possible stroke patient arrives at the door, the EMT has 30 seconds to give the assembled stroke team the five or six keys to action they’ll need for treatment. “It’s very structured, organized and scripted, No chaotic yelling or shouting orders
Over the past two years, St. Clair Hospital has treated more than 525 patients with stroke symptoms, says Cynthia Havilak, MSN, RN, executive director of nursing at St. Clair.
But, she says, “We see much a higher number of patients presenting to our ED door with stroke symptoms than those who are diagnosed or confirmed to have a stroke. Patients coming to the ED seeking treatment for stroke symptoms is a very good occurrence, and one we hope to see,” In other words: Folks, they want to see you at the ED door if you even suspect a stroke is happening.
“Pittsburghers are definitely a hardy breed,” observes Dr. Jason Biggs, head of St. Clair’s ED. “They’re much more likely to drive themselves to the hospital.” But don’t, he cautions. That burns up precious time – time the EMTs could use to monitor critical ‘last known well’ information so vital to effective treatment.
“Although the patient may not have had a stroke at that time,” she continues, “they may be found to have cardiovascular risk factors, and this may have been a warning event for them. We can help advise them on life style changes that can lead to improved health and reduce the chances of a stroke occurring.”
And consider: Stroke is the fifth leading cause of disability, reminds Leslie Pope. “This fact—disability —has a much bigger impact than death statistics. Disability can mean partial blindness in one or both eyes, causing an inability to read, which can be devastating.”
“We have a really good community hospital—we’re a designated stroke center. You don’t have to go to the city for high quality treatment. We have it right here.”