by Andrea Brassfield
Blessing Hospital recently recognized four members of the Scotland County Ambulance Crew as Stroke Care Heroes for achieving “Door to Needle Time for a Stroke Patient in Less than 60 Minutes”. Erick Byrn, Derek Ambrose, Angie Gilbert, and Rick Hale, were all on the scene at the Jim and Kathy Campbell residence February 6, 2017 after responding to the emergency call. As a result of their training in TCD (Time Critical Diagnosis), the crew was able to evaluate Jim’s condition as a stroke, order the helicopter, and alert Blessing Hospital they would be flying in a stroke victim. Blessing is the closest Stroke Center to our area.
Erick Byrn, who is both a Certified Flight and Critical Care Paramedic for Kirksville’s Air Evac 38 and the Scotland County Hospital EMS Director, said part of the credit for their success was due to the fact that Jim’s wife, Kathy, was able to recognize the “time of onset” of Jim’s stroke. Knowing the exact time the stroke occurred is crucial when determining if tPA, otherwise known as the “clot buster” can be used. Tissue plasminogen activator (tPA) is a medication that dissolves blood clots. It is an intravenous or IV medication usually given through a catheter inserted into a vein in the arm. tPA has been approved to treat brain attacks in the first three hours following the onset of symptoms. If given promptly, 1 in 3 patients who received tPA resolve their symptoms or have major improvement in their stroke symptoms.
This is why time is of the utmost importance for emergency medical crews. The faster a stroke is identified, the better chance the proper treatment can be administered increasing chances of recovery and decreasing the likelihood of permanent disabilities.
Byrn explained there are two types of strokes that have to be identified before a patient can be given tPA. The first type of stroke is Ischemic and is caused by blood clots that block the flow of blood to the brain causing tissue death. tPA is given to help dissolve the clot quickly and restore the blood flow to the brain. Byrn explained 87% of patients suffer this type of stroke, compared to 13% who suffer a Hemorrhagic stroke. A Hemorrhagic stroke is a brain attack due to bleeding from a blood vessel into the brain. tPA is not used with this type of stroke because it could increase the amount of bleeding and possibly cause more damage to the brain.
Byrn went on to explain the only way to know for sure which type of stroke a patient has suffered is through a CT scan or MRI of the head in order to confirm there is no bleeding in the brain.
The morning of Jim’s stroke, Derek Ambrose, who has been with SCH for more than seven years, and Rick Hale, who has been with SCH for two years, both SCH EMT Technicians, were the first to arrive on the scene. After Kathy explained what had happened and their evaluation, Derek and Rick recognized Jim as a stroke victim and following TCD regulations, calling in a helicopter. Next on the scene were Byrn and Angie Gilbert, an SCH paramedic for the past two years. Following his evaluation, Byrn called Blessing Hospital, letting them know Jim would be arriving there by helicopter.
The time for the helicopter to leave Kirksville and arrive at the SCH air pad was twelve minutes. Jim was taken by ambulance to Scotland County Hospital’s air pad and once he left there, it took 18-20 minutes to arrive at Blessing Hospital in Quincy. Byrn said that Connie Scott, Chairman of the Stroke Team at Blessing Hospital, said the ambulance crew’s actual recorded time from the time they initiated their emergency stroke protocol, alerted Blessing Hospital, and the patient’s arrival at Blessing was 43 minutes, indicating “this was either the quickest or second quickest response in the history of EMS in this region”.
Scotland County Hospital currently has eight PRN Paramedics, two full-time paramedics, four PRN EMTs, and 4 full-time EMTs on staff. Dr. McNabb serves as the Scotland County Ambulance Medical Director.
Scotland County Hospital implemented the Time Critical Diagnosis for their Emergency Medical Services on February 15, 2017. All emergency medical personnel have been trained in TCD. The closest Primary Stroke Center to this area is at Blessing Hospital in Quincy, IL. Columbia, MO and Iowa City, IA have Comprehensive Stroke Centers.
Family, friends, and coworkers can help EMS personnel by being aware of possible stroke symptoms. The American Stroke Association has developed the acronym F-A-S-T: Face Drooping (Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven or lopsided?), Arm Weakness (Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?), Speech Difficulty (Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the person able to correctly repeat the words?), Time to Call 9-1-1 (If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and say, “I think this is a stroke” to help get the person to the hospital immediately. Time is important! Don’t delay, and also note the time when the first symptoms appeared. Emergency responders will want to know). Other symptoms associated with strokes are sudden confusion, trouble speaking or understanding speech, sudden numbness or weakness of face, arm or leg; especially on one side of the body, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, sudden severe headache with no known cause.
Stroke is the fifth leading cause of death in the United States, taking more than 130,000 lives. Stroke is the leading cause of serious, long-term disability in the United States. Strokes can and do occur at ANY age, with statistics showing 34% of people hospitalized for stroke were less than 65 years old. Someone in the United States has a stroke every 40 seconds and every four minutes, someone dies of stroke.
Stroke Awareness Month is in May and is an annual event held within the United States. The aim of National Stroke Awareness Month is to reduce the impact and incidence of stroke.