By SARA ARTHURS
Fourteen percent of people with ischemic strokes — the kind caused by blood clots — make it to Blanchard Valley Hospital within three hours, in time to use what’s commonly called a “clot-busting” medication. That’s higher than national figures of about 8 to 10 percent.
But Cody Price and his colleagues at Blanchard Valley Health System want to increase that figure.
Price, a registered nurse, is chest pain and stroke programs coordinator for Blanchard Valley. The local health system spent over two years overhauling how it treats strokes, with a goal to “shave minutes off” the time it takes for people to get to the care they need. Just as they say “Time is muscle” with regard to heart attacks, time is brain, too, Price said.
The most common type of stroke is an ischemic stroke, caused by a clot blocking a blood vessel carrying blood to the brain.
Price said someone having an ischemic stroke has a three-hour time frame in which they can receive what’s generally referred to as “clot-busting” medication. Otherwise, “the risks will outweigh the benefits,” with those risks including dangerous bleeding, he said.
People might be tempted to wait and see if they feel better in a little while. But if you suspect you’re having a stroke, you should call 911 immediately, he said.
“Don’t get in the car,” said Roxanne Williams, the health system’s director of corporate quality and patient safety. “Call 911.”
For one thing, you might pass out on the drive and get into a wreck. But also, Williams said, EMTs can start giving you care immediately if you call 911. And the ambulance crew calls the emergency department at the hospital, letting them know a patient is coming in with a possible stroke. That way, you get seen by a health care provider right away, rather than going through triage in the emergency room.
“Minutes count,” Williams said. “Seconds count.”
If EMTs identify signs of a stroke, they will ask for the last time you were functioning like yourself — “last known well,” as the health care professionals call it.
The clot-busting drug can only be used within three hours for most people, although this might be up to four and a half hours if the person is otherwise young and healthy, Price said. When you arrive at the emergency department, they’ll get a brain CT to make sure there is no bleeding. If there is not, clot-busting medication can be used.
A telemedicine robot at the bedside allows a neurologist at Ohio State University to videoconference in and advise whether to give the medication. Sometimes, the doctor recommends transferring the patient to OSU for a thrombectomy, a process which surgically removes the clot.
The prognosis varies, depending on where in the brain the clot is happening, how large it is and any other medical conditions the person has.
Most stroke survivors go home from the hospital, and may receive home health care, but some must go on to a skilled nursing facility. Strokes can lead to long-term problems with speech, swallowing or walking. They can also affect a person’s cognitive ability or memory.
Price said stroke used to be the fourth leading cause of death. Now it’s fifth, as more people do survive.
A national campaign is underway to get lay people familiar with the acronym “FAST.”
In it, the “F” stands for “Face,” which may be drooping, usually on one side; “A” is for “Arm,” which may have numbness or weakness, again on one side; “S” is for “Speech,” such as slurred speech or difficulty finding words; and “T” calls for “Time,” meaning it’s time to call 911 right away.
And Blanchard Valley has earned The Joint Commission’s Gold Seal of Approval and the American Heart Association/American Stroke Association’s Heart-Check mark for Advanced Certification for Primary Stroke Centers. The Joint Commission is the independent organization that accredits and certifies nearly 21,000 health care organizations and programs nationwide.
To get the certification, the health system organized a steering committee for stroke and submitted an application detailing the processes they were working to improve. Then a Joint Commission official with an extensive background in stroke visited the hospital and looked at how patients, as well as staff, are educated and how the health system is working to improve processes. The certification is for 24 months, after which the Joint Commission will visit again.
As part of the project, the health system put together clinical practice guidelines from the American Heart and Stroke Association. They established a specific checklist, so staff know if a patient is experiencing certain symptoms he or she needs a CT right away. And, Williams said, they educated staff to recognize the urgency of these symptoms and take an “all hands on deck” approach. This includes not just staff in the emergency department, but everyone throughout the health system, such as dietitians.
Staff now wear, next to their name badge, a card with information on stroke risk. (The health system employs almost 3,000 people.) The idea is that if someone is, say, delivering a tray of food to a patient and sees the signs, they can recognize what’s going on, Williams said.
Price said risk factors for ischemic strokes are the same as for a heart attack. These include smoking, uncontrolled diabetes, high blood pressure, an inactive lifestyle and family history. Those who previously suffered a stroke or “mini stroke” (also known as “TIA” or “transient ischemic attack”) are also at higher risk, as are those with atrial fibrillation. People 65 and older are at increased risk, and many of the patients seen locally are in their 70s, he said.
The risk of stroke can be lessened through lifestyle changes. If you have diabetes, this includes taking your medication, eating a healthy diet and exercising. Similarly, if you have high blood pressure, it’s important to take prescribed medications.
Less common than an ischemic stroke is a hemorrhagic stroke, meaning a stroke involving bleeding rather than a clot. In this case, medical professionals will try to see where the bleeding is coming from, and stop it.
Genetics may put a person more at risk for a hemorrhagic stroke. And if someone falls, it can cause a brain bleed.
On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.