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Publication Date: Friday, October 10, 2003

Heading off stroke, El Camino Hospital comes to the fore Heading off stroke, El Camino Hospital comes to the fore (October 10, 2003)

By Diana Reynolds Roome

Strokes have a way of causing sudden devastation -- to the individuals who suffer them as well as their family, friends and colleagues. "Brain attacks" (as they are also known) happen when an interruption of blood supply to the brain causes cells to die off. They regularly knock out 700,000 people a year in the USA, killing 160,000 of them and leaving many with impaired ability to move, speak or work.

Most people would rather not think about such a scenario. But knowing that strokes keep happening -- and to younger age groups -- El Camino Hospital has been carefully considering its response. A task force of neurologists, nurses, emergency personnel and others are in the process of implementing a program that will ensure the very best of care to anyone who suffers a stroke.

Stroke codes for emergency response are already in place, with two teams of neurologists on call 24 hours a day. Data collection is designed to identify areas of weakness and continuously improve every aspect of stroke treatment. Plans for certification and a primary stroke center have been given the go ahead (though funding is an ongoing question).

El Camino's involvement is part of a pilot program being implemented by the American Stroke Association (a division of the American Heart Association). Termed Get with the Guidelines (GWTG -Stroke), it aims ultimately to improve stroke prevention and treatment nationwide.

Yet no matter how good a hospital's response and subsequent care, it is not only up to them. Recovering from stroke depends a lot on the individual -- or anyone who is present when someone suffers symptoms that may indicate an impending brain attack.

These can vary, but often include numbness on one side, dizziness or loss of balance, sudden difficulty seeing, speaking or understanding speech, and sudden severe headache. If any of these occur, it is vitally important to recognize their implications and call 911. "Time is brain," according to the ASA, and anyone with suspicion of stroke should not wait to call a doctor -- setting up an appointment can waste valuable time.

Decisive action is so important because it is now possible to reverse the effects of stroke -- most commonly paralysis, but also loss of speech and cognitive function -- by using a relatively new drug, tPA (tissue plasminogen activator). But there's a catch: it must be used within three hours of the onset of symptoms. This requires alertness and quick recognition of stroke symptoms, a test that few people pass.

"Only just over 4 percent of those who come in with stroke symptoms come in time," says Audrey Prairo, a clinical nurse in ECH's emergency department. This is a little better than the national average, but still disappointing. "The most frequent reason is non-recognition as to what stroke is."

If more people knew the symptoms of stroke, and reacted as fast as they would to a heart attack, fewer would suffer death and disabilities. Yet symptoms are often not taken seriously, partly because they often resemble lesser problems, such as fatigue or stress. People frequently assume that numbness or dizziness will pass. Even if they do go away, it is still crucial to get to a physician. This is because such passing "mini-strokes" are often forerunners to a larger event, and medications (to thin the blood or reduce blood pressure) may be necessary to prevent a catastrophe later on.

Stroke resources

El Camino Hospital is continuing its efforts to make people aware of the significance of stroke's most oft-ignored symptoms, and the community seems keen to learn.

"The first Community Stroke Screening on Aug. 9 attracted more than 140 people. Iit far exceeded our expectations," said Janet Piltz, an El Camino nurse who,- along with other members of the stroke team, organized 42 volunteer health workers for the event.

"There's a lot people can do to prevent strokes," said neurologist Ronald Hess, who is leading El Camino's stroke task force. Speaking to the audience at the screening event, he pointed out that recent research shows 80 perent of strokes are preventable if risks are systematically reduced.

How do we do that? "It's the same culprits that cause heart disease," says Hess. "But if I had to pick one thing that could save strokes, it would be lowering blood pressure."

This means getting regular checkups to make sure blood pressure and cholesterol levels are normal, and that there are no risk factors such as diabetes or heart disease present. It also means determinedly pursuing the gold standards of good health: giving up smoking, reducing weight, exercising regularly and eating a diet high in vegetables, fruit, and fish, and low in red meat and saturated fats (which often means processed and fast food).

Attendees at the ECH Community Screening received tests for blood pressure, pulse and glucose levels, as well as sleep apnea (another risk factor).

The Three Rs of minimizing stroke damage, says Hess, are: Reduce (stroke risk), Recognize (stroke symptoms), and Respond (to warning signs by calling 911). Anyone who learns these three Rs and acts on them could save their own life or someone's else. This includes people of all ages -- from students to seniors -- especially as a stroke can happen to anyone, regardless of age (However, the risk does climb after the mid-fifties, and 10,000 people in the USA are turning 55 every day).

Growing efforts to boost awareness

Although there is no legislation requiring a hospital to provide stroke emergency treatment, Santa Clara hospitals are working to improve their response, especially with the encouragement of such organizations as the ASA, the Peninsula Stroke Association (PSA), and Stroke Awareness (recently founded by Pat Dando, vice mayor of San Jose).

Meanwhile, the effort continues to make everyone, from first responders to emergency nurses, technicians and neurologists, fully aware of the need for fast and appropriate action. "With the emergency treatment of acute stroke, you have a requirement for many things to happen quickly," says Hess. "If you have one person who isn't aware that things must happen flawlessly, you can delay the process."

According to Scott Hochstetler, a paramedic for American Emergency Response, the process is working. "We got here with a stroke patient in two minutes [after notifying the emergency department], and they already had the CT scan ready. I'm extremely impressed."

Rezvan Moghaddam, executive director of Peninsula Stroke Association, agrees. "PSA is heavily promoting the idea that people should go to emergency when they experience symptoms of stroke," she said. "The first step is to get them to the doors, but the doors need to be open for them. This is why we are fortunate that El Camino is joining the other excellent stroke response hospitals in this area."

El Camino Hospital, 2500 Grant Road, Mountain View, CA 94039 For more information on stroke: or call 565-8485


Know the warning signs of stroke and act in time

With two or more of these warning signs, call 911:

Change in vision: Dim, blurred or confused vision, or sudden loss of sight in one eye

Difficulty with speech: Slurred or sluggish speech, loss of words or difficulty understanding words

Unexplained weakness: Clumsiness or loss of strength in the face, hand, arm, and/or leg on one side of body

Change in sensation: Heaviness, unusual or loss of sensation in the face, hand, arm and/or leg on one side of body

Severe headache: Unexplainable headache, often described as "first or worst" headache ever

Unexplained dizziness
Severe and sudden dizziness, not related to any sudden change in head position


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