October 25, 2002

VUMC, emergency workers to offer new stroke protocol

Featured Image

Robert J. Lefkowitz, Ph.D., James B. Duke Professor of Medicine at Duke University, delivered the 2002 Paul D. Lamson Memorial Lecture this week. His presentation focused on a family of molecules called beta arrestins and the role they play in cell signaling. The Lamson Lecture Series was established in 1964 to honor the late Dr. Lamson, who organized the VUMC department of Pharmacology and served as its first chair from 1925 to 1952. (photo by Dana Johnson)

VUMC, emergency workers to offer new stroke protocol

When someone suffers a stroke, every passing moment before appropriate treatment begins amounts to further brain damage and increasing impairment.

Thanks to sponsorship from Vanderbilt University Medical Center and the American Heart Association, Metro Nashville Emergency Medical Services (EMS) paramedics will be able to provide Nashville’s stroke victims more effective field evaluations, helping hospitals prepare for faster access to the best treatment options.

Dr. Corey Slovis, chairman of Emergency Medicine and medical director of the Metro Nashville Fire Department’s EMS program, along with five Metro EMS paramedics, recently spent several days undergoing new protocol training for emergency management of acute stroke at the University of Miami School of Medicine. The school’s program, which focuses on early recognition of stroke, then alerting the receiving hospital to the patient’s diagnosis and severity, is considered one of the nation’s best and is used as an EMS model in many major U.S. cities.

“Currently, only about 5 percent of stroke patients arrive at the hospital in time to receive t-PA (tissue plasminogen activator, a clot busting drug) because most people don’t know the warning signs, or don’t realize they should seek medical help immediately,” said Karen Giorgio, communications manager for the American Stroke Association, a division of the American Heart Association. “Improving early recognition of stroke, reducing the time to treatment, and controlling the risk factors for stroke are our best defenses in the war against stroke.

“We appreciate Vanderbilt University Medical Center’s recognition and financial support of this training which will strengthen the chain of survival in our community.”

Slovis and the paramedics attended a “train the trainer” program which focuses on teaching pre-hospital health care providers (paramedics and emergency medical technicians) how to recognize the signs and symptoms of stroke quickly and accurately; perform a rapid stroke assessment; and ask the patient a few key questions that hospitals need to know to plan appropriate treatment prior to the patient’s arrival.

“Because the public’s recognition of stroke is so low, most EMS calls are not identified as stroke. So it’s up to EMS to assess the patient’s condition as a stroke,” said Giorgio.

The protocol, which consists of asking the victim to respond to a series of verbal and physical commands, can provide information necessary to determine whether the patient is a candidate for intravenous anti-stroke therapy, or if the patient needs to go to a catheterization laboratory for interventional therapy.

The next step is mass education of all Metro Nashville EMS paramedics.

“About 700,000 people a year suffer a new stroke, or another stroke, in the United States. About one-third of those people die, about one-third become moderately disabled by their stroke, and only about one-third go on to fully recover or lead a semi-independent life,” said Slovis. “When you look at stroke survivors in the U.S., and there are more than 3 million of them, many require significant health care dollars to keep them alive on a daily basis. Stroke is the No. 1 cause of chronic disability in the U.S.”

According to the Centers for Disease Control and Prevention, and the American Heart Association, stroke is the third leading cause of death in the United States behind heart diseases and cancer. Americans will pay about $49 billion in 2002 for stroke-related medical costs and disability.

The National Center for Health Statistics ranks Tennessee, along with the rest of the Southeast except Florida, as having the highest incidence of cerebral vascular disease in the nation with more than 30 deaths per 100,000. Many health care professionals refer to Tennessee, Kentucky, and the rest of the Southeast as the stroke belt.

“It wasn’t that many years ago that if you had a stroke, that was it. There was nothing you could do for stroke,” said Slovis. “But there are new stroke therapies available now, and newer ones on the horizon.

“There have been efforts over the last several years to use t-PA to lyse a clot in the brain, but only about 3 percent of all stroke victims are potentially eligible for this drug. It has to be given within three hours of the acute onset of the stroke. There are a number of contraindications. But the only way you can even consider the use of this drug is to get people to a hospital quickly, have the emergency department staff rush the patient for a CT-scan, and have a stroke team activated.”

Slovis says that with paramedics effectively triaging stroke patients more people might be treated with t-PA intravenous therapy, intra-arterial therapy or with other therapies on the horizon.

“This is just the beginning,” he said. “I’m optimistic that with minimal additional training our paramedics can do an even better job of getting stroke victims to appropriate hospitals.”