If you recognize that someone is having a stroke, the first thing you should do is call an ambulance. Brain cells die quickly without blood flow — for every minute a stroke is not treated, a person loses 1.9 million cells — which is why neurologists use the phrase “time is brain” to emphasize the quick action stroke patients need for the best chance of survival and recovery. Strokes are a medical emergency, but many stroke patients walk in to emergency departments after driving themselves to the hospital or being driven by a loved one. One national study found that more than one third of stroke patients did not use emergency medical services to get to the hospital. In 2021, nearly a quarter of all stroke patients admitted to Froedtert Hospital did not arrive by ambulance.

“EMS providers are trained for stroke emergencies, and we want to educate people to use those services,” said Tom Engel, MD, assistant professor of emergency medicine at the Medical College of Wisconsin and assistant medical director for the Milwaukee County Office of Emergency Management. “This starts with improving recognition of stroke symptoms because it will be the first thing that leads to EMS being activated.”

Notice Signs of a Stroke: B.E. F.A.S.T.

Strokes can happen to people of all ages without warning, and one or more symptoms can appear suddenly. The acronym B.E. F.A.S.T. is a helpful way to remember the different signs of a stroke and a reminder to act quickly.

  • Balance: sudden loss of balance, leaning or staggering
  • Eyes: sudden loss of vision in one or both eyes or double vision
  • Face: facial droop or weakness or numbness on one side
  • Arm or leg: weakness or lack of coordination in the arm
  • Speech difficulty: difficulty speaking or understanding
  • Terrible headache: sudden onset of head pain

When You Call 911 for a Stroke, You Get Faster Treatment

When you call 911, you will be connected with a dispatcher who is trained to ask specific questions that will help responding emergency medical technicians (EMT’s) locate the patient and assess their level of severity. If you can adequately explain a person’s symptoms and the dispatcher recognizes they could be having a stroke, the EMTs will be dispatched with appropriate resources and will be well prepared.

“When patients are showing signs of a stroke, we educate our EMS providers to err on the side of caution and think of stroke as being one of the most likely diagnoses,” Dr. Engel said. “If a patient is less sick, we can pull back resources later.”
When the EMTs arrive, they identify the patient and immediately begin lifesaving interventions, if needed. If a stroke is suspected, the EMTs will do a quick assessment to make a positive or negative determination of the diagnosis using standardized criteria, called a prehospital stroke scale. If the patient is positive on the stroke scale, the EMT’s may further evaluate for a type of blockage known as a large vessel occlusion or LVO.  LVOs cause strokes that tend to be more severe and may require a higher level of care or intervention.

“If patients use the EMS system, they have a faster time-to-recognition-of-stroke and faster access to treatment,” Dr. Engel said.
During transport, an EMT will evaluate the patient, stabilize them if needed and also take measurements of vital signs, such as temperature, pulse, blood pressure and respiration rate. This information is provided as summary for hospital staff and can save valuable time.

Different Hospitals Offer Different Levels of Stroke Care

Hospitals have different capabilities when it comes to the type of stroke treatment they can provide. Assessments in the field, like the prehospital stroke scale, help EMTs determine the most appropriate hospital for the patient’s condition. The Joint Commission, a not-for-profit organization that sets standards on patient care, and the American Heart Association/American Stroke Association certify hospitals for different levels of stroke care based on hospital resources, staff and training for stroke treatment. In Milwaukee County, patients who test positive for an LVO are taken to the nearest Comprehensive Stroke Center, which is a hospital that offers the most advanced complex stroke care. Froedtert Hospital has been a Comprehensive Stroke Center since 2012.

“The Comprehensive Stroke Center at Froedtert Hospital is staffed 24/7 with specialists offering some of the most advanced complex stroke care in the region,” said Marc Lazzaro, MD, FAHA, an interventional neurologist at Froedtert Hospital and medical director of the Comprehensive Stroke Center. “We have a Neurosciences Intensive Care Unit with experts trained for critical care of stroke patients. Our program is built around treating acute stroke patients and making every therapy available in a timely manner to get the best possible outcome.” 

It’s a good idea to know what type of stroke care is available at your hospital of preference and other hospitals near you. A survey of stroke patients published in the American Heart Association’s medical journal Stroke found the main reason stroke patients and families decided not to call an ambulance and drove themselves to the hospital instead was hospital preference and not knowing where an ambulance would take them. In some counties, such as Milwaukee County, patients can request to be taken to a specific hospital, though this could add time to the transport. When someone having a stroke is taken to the appropriate hospital for the treatment they need, they have a better chance of survival and recovery.

EMS and Hospitals Coordinate for Stroke Alert Activation

There is a system of coordination between EMS and hospitals to provide stroke patients with the care they need as soon as they arrive at the emergency department. When EMTs are en route to the hospital, they communicate by radio with staff at an EMS communications center who will relay the alert to the hospital or directly with hospital staff, depending on the region. This triggers a stroke alert for the hospital’s emergency medicine, neurology, pharmacy and radiology teams to make sure they are ready and that a CT scanner is available so that the patient can be taken for brain imaging immediately.

“We are all working in parallel rather than sequentially to be able to deliver timely therapies,” Dr. Lazzaro said.

The time it takes a stroke patient to get to the appropriate hospital can also affect their treatment options. About 87% of strokes are ischemic strokes, which means they are caused by a blockage of a blood vessel in the brain. Clot busting medication can restore blood flow, but it is a time sensitive treatment because it needs to be given within a few hours of stroke onset. There is also a time limit on a clot-retrieval procedure. 

“Every minute counts,” Dr. Lazzaro said. “People should not wait out symptoms to see if they go away or delay getting to the hospital in any way if they notice a sudden onset of a focal neurologic deficit, such as problems with speech, vision or weakness. This necessitates calling 911 immediately.”

For more information about stroke care visit, https://www.froedtert.com/stroke.

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