Stroke: The EMS Response

by on January 2nd, 2011
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“Place the house dog car theer oaf gare.” Phillis said as she collapsed into the chair.

“Mom!” Katherine heard the slurring in the voice, saw her mother sag into the chair.

“Fillmore ambulance respond to 180 Blockage Road, 60-year-old female change in mental status, stroke-like symptoms. Medic 80 out of Warsaw responding to assist.”

Each year strokes — or Cerebral Vascular Accidents (CVA) — kill 133,000 people in the United States. CVAs are caused by a blockage in a blood vessel of the brain or a ruptured blood vessel. The loss of blood flow causes cells to start to die. The victim will suffer loss of speech, movement, cognitive thoughts, even death.

Symptoms range from slurred speech and facial drooping, to loss of consciousness and seizures. The patient may appear confused, have an unsteady gait or weakness on one side. They may be unable to communicate or their communication skills may be compromised. Immediate help is needed, so activate EMS.

“Mrs. Howard, I’m Karen with the ambulance. I need you to squeeze my fingers.” Karen, feeling the lack of grip in the left hand turned to her crew. “Request Life Net 77 and start her on high flow O2.”

Rapid identification can change the outcome for victims of a stroke. Even in rural America, the Volunteer Ambulance and Firefighters who respond are trained medical professionals. They are capable of rapid assessments and beginning timely treatment. Upon arrival of the Paramedic unit, the ambulance crew update the advance provider, who continues the assessment. This includes neurological checks, cardiac monitoring and a check of the person’s blood glucose.

Why blood sugar checks? Hypoglycemia is the great impersonator, it will mimic other illnesses. Hypoglycemia can exist even if the person has no history of diabetes. The treatment is administration of glucose to raise the blood sugar to normal levels. Other possible causes of stroke like symptoms include cardiac events and medication errors. These causes must be addressed immediately or the outcome could be devastating.

“Blood sugar is 90, normal,” the paramedic said. “Positive drooping on the left side.”

“Life Net 77 has a 10 minute ETA,” Karen said.

Once a stroke is confirmed, time is the enemy. Beyond the blockage, the brain is lacking oxygen and nutrients. Every minute, brain cells start to die. If this situation is not reversed, lasting damage will result.

Over the last 20 years, treatment of the stroke patient has improved and significant improvement in the patient’s condition is possible. A narrow window, three hours from the onset of symptoms, allows an opportunity to reverse some of the damage. Within this time, definitive care must be initiated. In the field, EMTs and Paramedics start by administering oxygen, establishing IVs and doing blood draws. They prepare to handle the complications from the stroke. These complications include: convulsions, seizures, heart arrhythmia, anxiety and respiratory compromises.

The patient will be transported to a stroke center, in many areas this mean using a helicopter. At the stroke center, the patient will undergo a CAT scan to rule out a brain bleed, then start receiving medication to break up the clot. From there, the hospital team, including a neurologist, will decided the best course of action to assist the person toward a full recovery.

Stroke is not the killer of 30 years ago as long as these four steps are followed. 1) Immediate recognition of symptoms. 2) Activation of EMS 3) Initiation of stroke care. 4) Transport to a stroke center.

These simple steps, done at the first sign can help a stroke victim recover to lead a long productive life.

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