In an ischemic stroke, a blockage in a blood vessel stops essential oxygen and nutrients from reaching the brain. (Photo/American Stroke Association)


by Caleb Hellerman

(CNN) — Despite public outreach campaigns, a third of all stroke patients don’t call an ambulance to get them to the hospital, leaving them vulnerable to delayed treatment and worse outcomes, according to a new study published in the journal Circulation.

The authors analyzed data on more than 204,000 patients, seen at 1,563 U.S. hospitals between 2003 and 2010. Patients who arrived by ambulance were about twice as likely to arrive at a hospital quickly, and were about 50% more likely to receive intravenous TPA — a clot-busting drug — within the recommended three-hour window, when it’s most effective.

“Time is the essence,” said Dr. O. James Ekundayo, the study’s lead author and an assistant professor at Meharry Medical College in Nashville. “The earlier to the hospital, the better — the earlier you’re evaluated and given treatment.”

“Time is brain,” adds Dr. Carolyn Brockington, director of the Stroke Center at St. Luke’s-Roosevelt Hospital in New York. She says about 85% of strokes are caused by a blockage in a blood vessel in the brain, which TPA can help unclog.

“People need to understand that every moment the brain is not getting enough blood flow, is producing an irreversible injury,” Brockington says. Depending where that is in the brain, it could be establishing a permanent disability.”

Younger stroke patients and ethnic minorities are less likely than others to call an ambulance, the study found. Interestingly, the same is true for patients with private insurance, who called emergency services less often than patients on Medicare or Medicaid; they even called less than patients with no insurance. Ekundayo says patients with some insurance plans might be reluctant to call 911, for fear of incurring high out-of-pocket costs.

Brockington says there’s also an element of denial. “Stroke is scary. People will tell you, ‘Oh, I thought I slept on my arm wrong,’ or ‘I thought I had a headache because I was just in an argument.’ But when you ask them later, ‘Did you really think that?’ They’ll say ‘No, not really.’ They knew something was wrong, but they just didn’t want to hit the panic button.”

While it’s jarring that many people don’t call for help, awareness actually seems to be improving: previous studies found that only half of stroke patients came to the hospital by ambulance.

Dr. Marilyn Rymer, a stroke specialist in Kansas City, says the news is mixed. “After all these years, you’d think we’d have the message out, but we really don’t.” Rymer is medical director for St. Luke’s Neuroscience Institute, a specialty stroke center which serves patients within a 200-mile radius. She says about 85% of those patients arrive by ambulance or helicopter. The hospital has raised awareness by inviting volunteer firefighters and other EMS providers to presentations on stroke care, she says. “It’s an organic learning process.”

One challenge, says Rymer, is that many people who suffer a stroke don’t realize what’s happening. “The brain is the affected organ, so you’re not processing things normally.” For this reason, she says, it’s important that people be alert to signs of stroke in friends and family members.

The American Stroke Association promotes a “F.A.S.T.” checklist, to recognize common symptoms:

– Face Drooping. Does one side of the face droop, or is it numb?

– Arm Weakness. If a person tries to raise both arms, does one drift downward?

– Speech Difficulty. Is speech slurred, or hard to understand?

– Time to call 911.

Other symptoms include sudden numbness or weakness in a leg, sudden trouble seeing out of one or both eyes, dizziness, confused behavior and sudden severe headache with no apparent cause.

The ASA says you should call 911 even if the symptoms go away before you get to a phone.


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