Not Calling 911 Slows Stroke Treatment

More than one-third of people having a stroke in the United States don't call 911, a study shows. And that can make a big difference in their treatment. The most effective treatment for ischemic stroke, the most common type, is use of clot-busting drugs. But they work best when given within 3 hours of the start of symptoms. In the new study, people who called 911 arrived faster than those who got to the hospital on their own. They also got treatment faster. The study looked at treatment of about 200,000 stroke patients from 2003 to 2010. Not everyone is eligible to get clot-busting drugs. Among those who were, 67% of those who came by ambulance got the drugs within 3 hours of when their symptoms started. Only 44% of those who got to the hospital on their own met that timetable. About 79% of those who got to the hospital within 2 hours of the start of symptoms came by ambulance. So did 61% of those who arrived within 3 hours. The journal Circulation: Cardiovascular Quality and Outcomes published the study. HealthDay News wrote about it April 30.

By Reena L. Pande, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Many people don't realize that stroke is the fourth largest cause of death in the United States. A stroke occurs when a part of the brain does not receive enough oxygen or nutrients. The cause is either a blocked blood vessel or a burst blood vessel in the brain.

People who survive a stroke can be left with major physical and mental limitations that can be life-changing. Early treatment of stroke can be life-saving and can limit the chance of having long-term disability. Unfortunately, many people do not get to the hospital quickly.

Calling an ambulance is the first step to getting the fastest treatment. A new research study reminds us that too few people having a stroke call an ambulance.

Researchers studied more than 200,000 stroke patients from more than 1,500 U.S. hospitals. These hospitals were evaluating a program called "Get With The Guidelines." This is an effort by the American Heart Association and the American Stroke Association to improve stroke and heart attack care. The program promotes use of set treatment plans that are based on the latest research.

Hospitals record certain measurements of care. For stroke care, they include:

• Time it takes from the start of stroke symptoms to hospital arrival and the start of treatment
• Number of people treated with clot-busting medicines
• The severity of stroke
• Number of patients who get education about stopping smoking and controlling blood pressure and cholesterol levels

These are just a few examples of the many measures that are included. The researchers in this study found that one measure in particular was worrisome. Too few people called an ambulance when they were having a stroke.

In fact, one-third of those who had stroke symptoms did not call emergency medical services. Instead, they got to the hospital on their own. This was more likely in rural areas and for minorities.

Here's why this matters. Clot-busting medicines can save lives and reduce disability. But they can only be given within a three-hour window from the start of symptoms. The longer it takes to get to the hospital, the less likely you are to get these life-saving medicines.

Taking an ambulance gets your treatment started much faster. Why? Emergency medical teams can give you medicines you need right away in the ambulance. They also know which hospitals are set up to take care of people who are having a stroke. This means you will get to the right hospital right away. You'll also be more likely to get the most appropriate treatments.

What Changes Can I Make Now?

First, you have to know the symptoms of a stroke and remember to get help fast. A good way to remember these tips is the mnemonic F-A-S-T.

F -- Face drooping or face numbness. If your smile is not equal on both sides, that may be a sign of a problem.

A -- Arm or leg weakness. Does one arm not work as well as the other?

S -- Speech problems. Are you having trouble speaking, or finding the right words, or even speaking gibberish?

T -- Time is of the essence. Call 9-1-1. As mentioned above, an ambulance can get someone to hospital and to life-saving treatments fast.

Other symptoms might signal a stroke as well. They include:

• Sudden confusion
• Sudden vision loss
• Sudden balance troubles

It's also important to remember the factors that increase your risk of stroke. They include:

• High blood pressure
• Atrial fibrillation (an abnormal heart rhythm)
• Diabetes
• Smoking
• High cholesterol
• Obesity
• Lack of exercise

What Can I Expect Looking to the Future?

About 800,000 people have strokes each year in the United States. It is clear that the faster you get the treated for stroke, the better off you will be. I hope that better awareness about stroke symptoms of stroke and the need to get treated quickly will reduce the number of people with major limitations after having a stroke.

Programs like "Get With The Guidelines" will continue to help us understand the things we do well and the things we could do better with stroke care. Picking up the phone and calling 9-1-1 with any possible stroke symptoms is one way that we could all do better.