Stroke treatments are increasingly effective in erasing the often-devastating effects of stroke, yet far too few people who see or have a stroke do the one thing that could save them from a lifetime of disability.
That one thing? Calling 9-1-1.
Research from the Heart and Stroke Foundation shows that 57 per cent of Saskatchewan residents say they would call 9-1-1 if they witnessed a stroke, however the reality is that far too few stroke patients reach hospital quickly enough to access stroke treatments that can, if given in time, reverse the effects of ischemic stroke.
While there is growing awareness of the signs of stroke (sudden weakness or dizziness, vision problems, difficulty speaking or a sudden severe headache) too many people still hesitate to call 9-1-1.
"This tells us there is a real problem," says Gwen Gordon, Director of the Stroke Strategy for the Heart and Stroke Foundation of Saskatchewan. "Driving the person to hospital yourself (or worse, waiting for symptoms to pass) will create delays at a time when every minute counts. Calling 9-1-1 gets you to the right hospital fast and allows the paramedics to communicate with the hospital so they are standing by to deal with a stroke immediately, as soon as the ambulance arrives."
Dorothea Warren, director of emergency medical services for Saskatchewan Health, agrees. "Paramedics and emergency personnel would far rather be called via the 9-1-1 system than be called hours later, when there is no chance for a stroke patient to receive new clot-busting treatments like tPA.
"Saskatchewan has a bypass protocol for emergency medical personnel who suspect a stroke. This means the ambulance does not necessarily take the patient to the local hospital or health centre, but instead can go directly to the nearest hospital equipped with a CT scan and the ability to administer tPA."
Gordon says there is a small window of opportunity to administer tPA; just a few hours from the first onset of symptoms. However, brain cells die quickly following a stroke, so the sooner the drug is given, the better the chance that brain cells can be saved and the better the chance for a full recovery. The drug cannot be given after 4.5 hours, so once that time period has passed there are few treatment options that can help reduce the amount of disability.
This can be a challenge in rural and remote areas of the province, she says, and it underscores the importance of recognizing the signs and acting immediately. Even if you are hours away from a major hospital, calling 9-1-1 is your best chance of reaching the hospital in time.
No one knows better than Lee Cayer, an active mom and horsewoman from the wide-open farming and ranching country of Southern Saskatchewan. Last year, at 44, she suffered a major stroke. Unable to stand or to call for help, she was fortunate that a friend and her husband suspected stroke and quickly called 9-1-1. Despite the rural location, the ambulance arrived in just over an hour, and took her directly to the nearest tPA-equipped hospital. The stroke team was standing by when she arrived and she was rushed through emergency and whisked off for a CT scan.
She recalls: "At 12:15, the tPA was put into my IV line and within six minutes I could move my finger tips; six hours later I was moving my arm. When I saw the doctor later that afternoon, he told me how I was so fortunate to get to the hospital on time. I realize now the importance of timing with a stroke. For me, it was the difference between a lengthy hospital stay and months of physical rehab or walking out of ICU on my own two feet, two days later."
The Heart and Stroke Foundation is working to bring about systems change, so that stroke is more preventable and better managed. However, if and when a stroke happens, calling 9-1-1 to get people to emergency as soon as possible is where the rubber hits the road.
Stroke is the country's third-leading cause of death and the leading cause of adult disability. Every 10 minutes, a Canadian suffers a stroke. Of every 100 people who have a stroke, approximately 15 will die, 10 will recover completely, 25 will recover with a minor impairment or disability, 40 are left with moderate to severe impairment and 10 will be so severely disabled that they require long term care.
