Contra Costa Times: New stroke procedures in Contra Costa County aim to provide speedier treatment

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Contra Costa Times: New stroke procedures in Contra Costa County aim to provide speedier treatment  

Local residents who undergo a stroke may receive faster treatment and suffer less brain damage as a result of new procedures implemented this week by Contra Costa County, medical experts say.

Emergency crews will now quickly determine whether someone appears to be having a stroke and will alert one of seven participating hospitals that a potential stroke patient is on the way.

That will give hospitals time to make sure that a CT scanner, a neurologist and other staff will be available -- either on-site or through an electronic link -- for quick assessment and treatment upon the patient's arrival.

The new rules apply around the clock and should save valuable time in getting care to patients, said Patricia Frost, the county's emergency medical services director.

"We're very happy and excited about the change," said Dr. Raymond Stephens, a neurologist and co-director of John Muir Medical Center's stroke program. "Brain death occurs very rapidly, in the first few hours after a stroke takes place."

In the past, emergency crews only sporadically gave hospitals a heads-up that they were bringing in a stroke patient. And they didn't necessarily transport people to hospitals with certified stroke centers, indicating that the institutions have the expertise, staffing and track record of caring for such patients, Frost said.

The new program is similar to one that Alameda County has had in place for five years, said Dr. Karl Sporer, medical director for Alameda County Emergency Medical Services.

In Contra Costa County, the participating hospitals are the John Muir campuses in Walnut Creek and Concord, Doctors Medical Center in San Pablo, San Ramon Regional Medical Center and Kaiser Permanente hospitals in Walnut Creek, Antioch and Richmond.

In Alameda County, the participating institutions are Alameda Hospital, the Alta Bates Summit campuses in Oakland and Berkeley, Eden in Castro Valley, Washington in Fremont and Kaiser hospitals in Oakland and Fremont.

Years ago, there was little medical experts could do for stroke patients. But today, scientific advances have made several treatment options available, which adds to the importance of getting quick care, Sporer said.

A stroke occurs when an artery to the brain becomes blocked or ruptures. Brain cells become deprived of their blood supply and the oxygen and glucose it provides. If this occurs for a short period of time, the brain cells may be stressed but may recover when blood is restored.

But if this happens for a longer period, the brain cells die. People who survive may become permanently disabled.

Stephens stressed that it is important for people to recognize stroke warning signs and call 911 as quickly as possible.

Symptoms include sudden muscle weakness or paralysis on one side of the body, difficulty speaking, confusion, dizziness, problems with vision and loss of balance and coordination.

It is important for family members to call an ambulance rather than drive a loved one to the hospital, Stephens said, because emergency crews will notify the hospital so the staff can prepare in advance for the patient's arrival.

"The worst thing to do is call your doctor's office," Stephens said, because that can lead to delays, especially if people can't reach the doctor right away.

"Don't brush your teeth and comb your hair" or prepare an overnight bag for a hospital stay, Stephens added.

If it takes longer than eight hours to get treatment, many brain cells may have already died.

"People are saying about four hours is a good treatment window to improve outcome for these patients," Frost said. "But we still have the majority of our patients walking into an emergency room hours after they could have been successfully intervened on. We need to reverse that."

Upon arrival at the hospital, most stroke patients will receive a quick CT scan to help determine whether they are having an ischemic stroke, which is caused by a blockage, or one caused by a rupture.

For ischemic strokes, doctors can deliver a type of medication called a tissue plasminogen activator to break up clots and help restore blood flow to the brain, Stephens said.

If that doesn't work, Sporer noted that some hospitals have experts that can do other interventions, including using a tiny corkscrew-shaped device to pull out a clot.

Emergency crews and dispatchers in Contra Costa County have been educated about what questions to ask to determine if someone may be having a stroke, said Mia Fairbanks, the county's stroke program coordinator.

"We anticipate that within a year or two, we'll have 100 percent of our hospitals stroke-certified," Frost said.

  • Weakness or paralysis on one side of the body
  • Difficulty speaking or slurred speech
  • Confusion
  • Dimness, blurring or loss of vision, especially in one eye
  • Dizziness or loss of balance and coordination
  • A severe headache with no known cause

If someone appears to be having a stroke, medical experts urge you to call 911 immediately rather than delaying or driving the person to the hospital yourself because emergency crews will notify the hospital, and staff can prepare for your arrival.