Lifesaving Advice for Stroke: Call 911

Dialing 911 for an ambulance is the best way of ensuring rapid, potentially lifesaving care in the event of a stroke, say two studies reported at the American Stroke Association annual meeting.

One study reported that patients who arrived at the emergency department by ambulance were seen and evaluated by doctors within
30 minutes, compared to 34 minutes for those who walked in, and 55 minutes for those coming by public transportation.

That four-minute difference might not seem like much, but as Dr. Yousef M. Mohammad, director of the stroke fellowship program at Ohio State University, points out, "a stroke is an emergency, and 'time is brain.' If you walk in or come by car or taxi, we are losing valuable time here."

Arrival by Ambulance a Plus

Dr. Mohammad's study, done with the help of the Zeenat Qureshi Stroke Research Center in Newark, N.J., examined data on more than 630,000 stroke patients treated in emergency rooms.

About half of them arrived by ambulance, 43 percent were listed as walk-ins (meaning they came by car, taxi, bus, or on foot), and 4 percent arrived by other means, such as police cars.

There was a difference not only in the time of service but also the kind of service given.

Brain imaging by computed tomography (CT scan) or magnetic resonance imaging (MRI), an essential diagnostic tool, was given to 73 percent of those coming by ambulance, 63 percent of the walk-ins, and 60 percent of those arriving by other means.

In addition, 97 percent of those arriving by ambulance were evaluated by a staff physician, rather than a nurse, physician assistant, or physician-in training, compared to 89 percent of walk-ins and 82 percent of those arriving by other means.

And 93 percent of those arriving by ambulance were admitted to the hospital or intensive care, compared to 58 percent of the walk-ins and 52 percent of those arriving by other means.

There is a message for the medical community in those numbers, notes Dr. Mohammad.

"Patients arriving by ambulance being seen earlier - this is wrong," he says. "There should be a change in protocol, so that patients who do not come by ambulance should be treated as urgently as those who do."

Speed Is Critical

But the main message is for people who experience the sudden numbness, confusion, trouble seeing, trouble walking, or severe headache that are the symptoms of a stroke, says Dr. Mohammad.

"Call 911, and the medical emergency staff will get you to the hospital quicker than you can drive yourself," he says.

The second study looked at 493 stroke patients in the Portland, Ore., area who either did or did not receive recommended CT scans to assess their strokes.

Overall, only 36.1 percent of them got the scans within the recommended 25 minutes of arrival at the hospital, says C. Ken House Jr, manager of outcomes and performance management for Cascade Health Community.

One of the major factors for patients in getting a scan was arriving in an ambulance, especially in noticeable fashion, says Dr. House.

"They tend to get treated more urgently and faster," he says. "All of the reasons are not particularly clear, but it does seem that patients who arrive via ambulance, particularly with the lights and siren going, tend to be considered for a brain scan."

His advice is the same as Dr. Mohammad's: "If there are any symptoms of a stroke, call 911 and activate the emergency system rather than waiting."

Always consult your physician for more information.