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Stroke victims don't call 911, delay crucial treatment
In an ischemic stroke, a blockage in a blood vessel stops essential oxygen and nutrients from reaching the brain.
April 30th, 2013
01:12 PM ET

Stroke victims don't call 911, delay crucial treatment

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. 


soundoff (7 Responses)
  1. Mrs. William Clogston

    I am a fan of both Dr. Gupta and Dr. Cohen, but this is a brain question for Dr.Gupta. My first husband passed away in 1979 and I am told he was the first ever diagnosed with Chromosome 17 Disinhibition Dementia, Parkinsonian, Amyotrophy Complex. It was determined the inheritence rate was 50%. My once brilliant son began to deteriorate in his thirties and we were estranged from his father's family since I divorced him due to frightening behavior. However I did go to see him in Columbia in NYC where he was diagnosed and I was told my son had a 50% inheritance chance.
    My once brilliant son began to deteriorate in his early thirties and has been hospitalized for the past 12 years. However one research doctor put him out of the research because he did not have tau or progranulin disorders. He was declared well by this one doctor. My son is still hospitalized with a new diagnosis of Incurable Paranoid Schizophrenia and although there were some family members diagnosed as schizophrenics, no research doctor will anwer us because of the findings of this one doctor. However this is still research. The DDPAC site is 17 q-21-22, while there is a schizophrenia site at 17-q-21. I know our President Obama has allocated money for brain research and I want him to know about this. We have essentially been put out of the research on the findings of one doctor and one lab. For myself, I want to know why the best and the brightest on this family spend their lives helping others while the famous worldwide psychopaths only engage in war and destruction for their own gain.

    April 30, 2013 at 17:07 | Report abuse | Reply
  2. Barbara

    Unfortunately, these symptoms are the same exact symptoms I have when I get a migraine. My father and grandmother both had strokes, so I'm hoping there will be a difference in the way the symptoms feel between the migraine and the stroke.

    April 30, 2013 at 20:10 | Report abuse | Reply
  3. Jalen

    Had the exact same symptoms (severe) once from a bad reaction between two medications. Unfortunately alot of things can cause these symptoms.

    April 30, 2013 at 20:45 | Report abuse | Reply
  4. sickofthebull

    3 Years ago my mum had a severe stroke, an ambulance was called as she couldn't see and was talking jibberish, unfortunately the inexperienced and uncaring emergency room staff kept her waiting for 3 hours "because she looked ok to them". We had to keep asking for them to help, but thankfully she had taken aspirin that morning. Stroke symptoms can come on quickly and can be undistinguishable from other illness and the person may be completely unaware anything is happening.

    April 30, 2013 at 23:53 | Report abuse | Reply
  5. Nguyễn Long

    Người phương Tây muốn khôi phục trạng thái ban đầu càng sớm càng tốt, người phương đông xem đó là cơ hội để thay đổi! Vì thế, kết quả nghiên cứu không bao giờ là chân lý

    May 1, 2013 at 10:57 | Report abuse | Reply
  6. Catwing

    Both my maternal grandparents had strokes. My grandmother had three severe strokes when I was between 7 and 12 years old. When my mother had a stroke at 47, I knew the signs and called 911 – the paramedics (yes, paramedics) didn't believe it was a stroke and asked me several times if she had been drinking. Seriously??? When my grandmother had her last stroke, we were in the emergency room for hours trying to get a doctor to look at her. Moral of story – learn signs, INSIST on treatment.

    May 1, 2013 at 23:03 | Report abuse | Reply
  7. Timmy Suckle

    Most people wait because they can't afford the care. Because of ME!!! I kissed my way up to VP at a health insurance company. Now I take over $600,000 of your health care dollars for NO VALUE ADDED to your health care. And that’s just me. Now think about how many other VPs, Directors, Managers, etc. are at my company alone. Now multiply that by thousands of others at hundreds of other health insurance companies. From 10 to 25% of your health care dollars go towards administration that adds NO VALUE to your health care. But my company’s PAC dollars will continue to fool you little people into thinking that a single payer system will be bad. Little people like you are so easy to fool. Little people also don’t realize that a single payer system is the ONLY system that would allow little people (as an entire country) to negotiate better health care prices. Little people don’t realize that the Medical Cartels already know that. And that is the reason why the Medical Cartels spend so much PAC money from the hospitals and doctors lobbying against a single payer system. Some little people say that a single payer system would cost you little people more. But if that were true, then wouldn’t the hospitals and doctors WANT that extra money? Yes they would. So why do the Medical Cartels lobby against a single payer system? It’s because the Medical Cartels know it would allow little people to negotiate better health care prices. And that’s what the Medical Cartels are afraid of. Period.
    But us big wigs at insurance companies, hospitals, and pharmacy companies don’t ever need to worry about health care no matter what it costs. We get our health care paid for one way or another by you little people. And we get the little people that work at our companies to contribute to our PACs. And us big wigs say it’s to protect the little peoples’ jobs. But in reality it would be in the little peoples’ best interest to NOT contribute to the PAC. Again, little people are so easy to be fooled. I won’t ever have to worry about losing my job with so many little people being brain washed by the Medical Cartels’ PAC money. Not only that, the Medical Cartels’ PAC money is used to elect so many republicans that will never allow a single payer system. Republicans have always fought against any meaningful health care reform. But that’s what our Medical Cartels’ PACs pay them for. Politicians can be bought so easily.
    Pretty soon the only people that will be able to afford health care is us big wigs. And that’s the way it should be. We don’t want you little people using up the resources when we need them. And once again, I thank you little people for capping my SS tax at the $113,700 level. Now I only pay 1.2% SS tax and you little people pay 6.2%. Also, thank you for extending my tax breaks. I’m using the extra money on my vacation houses.

    May 2, 2013 at 10:51 | Report abuse | Reply

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.