Stroke policy aims to quickly save lives

County residents suffering acute strokes will be immediately taken to specific hospitals for treatment under a proposed policy that aims to get preventative treatment to patients as quickly as possible at facilities that make stroke care a priority.

The Board of Supervisors is scheduled to consider the emergency service directive at its Tuesday meeting. If passed, the number of patients with acute stroke symptoms taken to a specific stroke center is estimated to jump from 5 percent to 90 percent. The policy’s approval will also make San Mateo the only Bay Area county employing a two-tiered approach to care and one of the few in California with a specific stroke care system for 911 callers, said Doris Estremera of the county Health Department.

The proposed plan was also lauded by stroke advocates.

"The new San Mateo policy is the best in California at integrating EMS transport and hospital treatment capabilities into a countywide stroke care system,” said Bob Parsons of the Stroke Awareness Foundation.

A six-month study of 911 calls in San Mateo County showed 33 patients with symptoms for less than three hours and nine between three to eight hours. An extra 22 patients didn’t enter the system until more than eight hours passed after symptoms began.

To qualify as a specialized stroke center, a hospital must have at least one neurologist on site 24 hours a day, seven days a week and a certain level of technology and pharmaceutical expertise. Technicians for CT scans must also be available to cut down on delayed care.

The policy directs ambulances to a primary stroke center if symptom onset is less than 2.5 hours, Kaiser Redwood City or Stanford Medical Center if onset is longer than 2.5 hours but shorter than eight hours and the closest hospital if onset is longer than eight hours.

Stroke is the third leading cause of death in the United States and survivors can be significantly disabled.

Approximately 80 percent or more of the 700,000 strokes suffered by Americans annually are classified "ischemic,” meaning they are caused by an arterial blockage. These types can often be treated successfully with drugs — often a genetically engineered clot-dissolving drug made by Genentech — but only if the patient is correctly diagnosed in a narrow window.

Once Mills-Peninsula Hospital and Seton Medical Center begin performing invasive procedures, they can receive patients with longer onset. These procedures include giving the drug that dissolves blood clots in patients with symptoms less than three hours. In patients when more than three hours have passed, a catheter can sometimes be threaded into the brain’s blood vessels to remove the blood clot.

Many in the medical community compare current stroke care to trauma reactions decades ago. Rather than head to a hospital best suited for serious patients that needed immediate attention, paramedics took people to whatever was closest. After strong pushing by surgeons and the medical profession, counties and states changed rules about patient transport. As a result, the most severely injured were taken to sites ready to deal with that level of care and countless lives were saved.

Currently, many hospitals do not have a neurologist on staff round-the-clock and other emergency doctors have little treatment in stroke and stroke care, according to the Peninsula Stroke Association.

Adding to the diagnosis difficulty, many who suffer a stroke either won’t know what hit them or will not be able to communicate that to others. Certifying hospitals as stroke centers and giving medics directives based on symptoms is aimed at keeping patients alive regardless of assumed diagnoses or lack of communication.

San Mateo County Medical Center does not currently plan to become certified as a primary stroke center but is implementing the same guidelines to rapidly transfer patients when necessary.

Info box: The Board of Supervisors meets 9 a.m. Tuesday June 19 in Board Chambers, 400 County Government Center, Redwood City.

Michelle Durand can be reached by e-mail: michelle@smdailyjournal.com or by phone: (650) 344-5200 ext. 102.

Info box:

Warning signs

• Change in vision: Dim, blurred or confused vision, or sudden loss of sight in one eye;

•Difficulty with speech: Slurred or sluggish speech, loss of words or difficulty understanding words;

• Unexplained weakness: Clumsiness or loss of strength in the face, hand, arm, and/or leg on one side of body;

• Change in sensation: Heaviness or unusual loss of sensation in the face, hand, arm and/or leg on one side of body;

• Severe headache: Unexplainable headache, often described as the first or worst headache ever;

• Unexplained dizziness: Severe and sudden dizziness, not related to any sudden change in head position.

— Information courtesy of the Peninsula Stroke Association