Proper EMS Response for Stroke Patients

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Stroke is the second leading cause of death worldwide, and in the United States someone suffers from a stroke every 45 seconds. Because of this it is imperative for first responders to get stroke patients to a hospital with a CAT-scan machine and a stroke team immediately. Patrick Lyden, MD, of the UCSD Stroke Center and James V. Dunford, MD, the City of San Diego's Medical Director, recently spoke about this during the "When Every Second Counts: Stroke Treatment Inside the Ambulance" seminar at Firehouse World in San Diego, California.

As controversial as it may sound Dr. Lyden and Dr. Dunford told the EMT's in attendance that there is not much that can be done in the field for stroke patients, and that the most important thing that they can do once they evaluate the patient is to get them to a well-prepared facility with a CAT-scan machine. Dr. Lyden says that first responders can quickly evaluate the patient by observing and reporting on four basic things. He says that they must check to see if the person's face is symmetric, if there is a drift in the patient's arms, and to listen to their quality of speech. Also, if possible, it is important to try to get a time that the incident began from a witness.

Dr. Lyden says that in many cases a person with a massive hemorrhage may have hypertension with blood pressure of 250 over 180, and it is the natural response of many EMT's to want to treat the blood pressure. However, he cautions them not to do this, saying that it is imperative to get them to the hospital with a CAT-scan machine to determine what kind of stroke the person is having.

Craig Balderson, a San Diego EMT in attendance at the seminar, says that his department follows the protocol that Dr. Lyden and Dr. Dunford recommend. He says, "If we are aware that a person has symptoms of a stroke, then we're going to activate the stroke team at the nearest facility to get them prepared for our arrival to get them in as soon as possible."

Unfortunately, some fire departments and ambulance services face challenges in getting stroke patients to the right facility. Their hands are often tied by city or county protocol that mandates them to transport patients to certain facilities no matter what. Dr. Lyden says that in some cases, these hospitals are not equipped and do not have staff with the specialized training needed to treat stroke patients. Because of this, Dr. Lyden and his colleagues will continue to raise awareness about the need for immediately transporting patients to hospitals that are equipped to treat stroke victims.

In testament to their message and in praise of the first responders who saved her life by quickly transporting her to a stroke center, stroke survivor Vicki Powell says, "The work that you do and the timeliness of the kinds of responses that you make in incidents of stroke is so important, and anytime that you need to feel that what you do is really making a difference in somebody's life look at the difference in me. Part of why I am as well as I am today is because of the response of my "Blue Angels" down the hill."

For more information on strokes, their warning signs, and symptoms, please visit the American Heart Association website.