Stroke Victims Are Often Taken To Wrong Hospital

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Stroke Victims Are Often Taken To Wrong Hospital

Outdated Ambulance Rules, Inadequate ERs Make Dangerous Ailment Worse
Lessons From Trauma Centers

By THOMAS M. BURTON
Staff Reporter of THE WALL STREET JOURNAL
May 9, 2005; Page A1

Christina Mei suffered a stroke just before noon on Sept. 2, 2001. Within eight minutes, an ambulance arrived. Her medical fate may have been sealed by where the ambulance took her.

Ms. Mei's stroke, caused by a clot blocking blood flow to her brain, occurred while she was driving with her family south of San Francisco. Her car swerved, but she was able to pull over before slumping at the wheel. Paramedics saw the classic signs of a stroke: The 45-year-old driver couldn't speak or move the right side of her body. Too often, stroke victims are taken to the closest hospital rather than one with the ability to treat stroke effectively. This increases the chances of death, brain damage or paralysis. See some common stroke symptoms and treatments0.

Had Ms. Mei's stroke occurred a few miles to the south, she probably would have been taken to Stanford University Medical Center, one of the world's top stroke hospitals. There, a neurologist almost certainly would have seen her quickly and administered an intravenous drug to dissolve the clot. Stanford was 17 miles away, across a county line.

But paramedics, following county ambulance rules that stress proximity, took her 13 miles north, to Kaiser Permanente's South San Francisco Medical Center. There, despite her sudden inability to talk or walk and her facial droop, an emergency-room doctor concluded she was suffering from depression and stress. It was six hours before a neurologist saw her, and she never got the intravenous clot-dissolving drug.

In a legal action brought against Kaiser on Ms. Mei's behalf, an arbitrator found that her care had been negligent, and in some aspects "incomprehensible." Today, Ms. Mei can't dress herself and walks unsteadily, says her lawyer, Richard C. Bennett. The fingers on her right hand are curled closed, and she has had to give up her main avocations: calligraphy, ceramics and other types of art. Kaiser declined to comment beyond saying that it settled the case under confidential terms "based on some concerns raised in the litigation."


(snip)

Write to Thomas M. Burton at [e-mail]

URL for this article:
http://online.wsj.com/article/0,,SB111559698348927772,00.html

[Horse with no Name]

1. That was malpractice by the physician and the EMS-not necessarily hospital

Just some info here.
1. Detection
2. Dispatch
3. Delivery
4. Door
5. Data
6. Decision
7. Drug

That is protocol for stroke.

The EMS role assessment in this is:
1. Cincinnati Prehospital Stroke Scale (includes difficulty speaking, arm weakness, facial droop)
2. Los Angeles Prehospital Stroke screen
3. Alert hospital to possible stroke patient
4. Rapid transport to hospital.

Immediately upon arrival to the hospital (in the first 10 min from the ambulance)
1. Assess ABC's, vital signs
2. Oxygen
3. Start an IV, blood drawn, blood sugar
4. 12-lead EKG
5. neurological screen
6. Most hospitals will have a stroke team which should have been notified.

There is then a next step of actions that are to be done in the first 25 minutes, but neither the EMS nor the physician initiated the stroke protocol.

Everyone remember....in order to get the fibrinolytics...IT MUST BE WITHIN 3 HOURS OF THE STROKE. It can't be started after that.
It's too late. Most protocol is that it is begun within an hour of hitting the hospital.
Keep this in mind if your loved one has the symptoms of a stroke.
TELL the EMS if you suspect a stroke that you want STROKE PROTOCOL initiated, if they have not already done so.
Unfortunately, sometimes we have to take our own healthcare in our hands--but the one thing that is certain, Nobody cares more about you or your loved ones than you do. Step up.