Saving Lives for Stroke Patients

Swift Response Helps Local Man Thrive After Stroke

When Barbara Ramm heard a loud thud, she thought something had hit her house. Downstairs, she found her husband Wolf, 69, sitting on the floor, unable to  speak. The right side of his face was drooping. He was having a stroke.

EMS paramedics quickly transported Wolf to the Inova Alexandria Hospital Stroke Center where the entire stroke team was waiting for him in the Emergency Department. When Barbara arrived a few minutes later, doctors were ready to give Wolf an injection of the clot-busting drug tPA. The total “door-to-needle” time: a remarkable 13 minutes.

Door-to-needle time refers to the time between a stroke patient’s arrival in the Emergency Department and the moment medication is administered. The American Heart Association (AHA) and the American Stroke Association recommend door-to-needle time at 60 minutes or less. The national average is 76 minutes. Even in stroke hospitals dedicated to improving treatment protocols, investigators report that less than a third of patients are treated with tPA within the hour guideline.

Swift Response
Inova Alexandria Hospital Stroke Center has been working diligently to reduce its door-to-needle time.

“We’ve implemented changes and improvements to create a seamless continuum of care for our stroke patients,” says Jalil Bentaleb, RN, Stroke Program Coordinator at Inova Alexandria Hospital. “Our emergency and stroke staff developed joint protocols to quickly identify and treat stroke patients within the nationally recommended goals. And we were the  first hospital in Northern Virginia to collaborate with EMS providers in the field  to flag incoming stroke patients. This  partnership is now a best practice.”

Here’s how it works: First responders from the city of Alexandria’s EMS perform an EKG and other neurological examinations at the scene and transmit the results via ambulance computer to the Inova Alexandria Hospital Emergency Department where a physician makes a diagnosis. If the patient is having a stroke, the charge nurse quickly mobilizes the rapid response stroke team, which includes interventional neuroradiologists, the stroke coordinator, an Emergency Department physician, neurologist, pharmacist, registration clerk and CT tech.

The team works together to prepare the CT scan and medications while the ambulance is en route. When it arrives, the team quickly registers the patient, performs a CT scan and administers the necessary medications. “These process improvements have helped reduce door-to-needle times well below the national threshold,” says Lewis Eberly, MD, Director of Neuroscience and Stroke at Inova Alexandria Hospital.

Primary Stroke Center
Inova Alexandria Hospital was recently designated a Primary Stroke Center for the ninth year. This gold seal of approval from The Joint Commission recognizes facilities that make exceptional efforts to meet the unique needs of stroke patients. “Joint Commission surveyors called us a ‘well-oiled machine’ and asked permission to share three of our best practices on their website,” Bentaleb says.

The hospital also participates in AHA’s “Get with the Guidelines” stroke initiative to educate patients about the importance of timely treatment. “We use the expression ‘time is brain’ to let people know that the faster they get to the emergency room, the better their chances of a positive outcome,” says Larisa Golding, RN, Patient Care Director. “If you were having chest pain, you wouldn’t hesitate to call for help, but people with stroke symptoms often wait to see if they will go away. Delay can be fatal. Early medical treatment reduces the risk of death or disability from stroke.”

For Wolf Ramm, fast treatment not only saved his life, but also greatly improved his outcome. Within an hour, he was able to talk. The right side of his face returned to normal. He gradually regained his fine motor skills. Four days later, he walked out of the hospital. The retired Federal Reserve Board staff member is now back to many of the activities he loves.

Barbara Ramm has high praise for the community hospital where her sons were born and her family has gone for medical care over the years. “I can’t say enough about the exceptional treatment that Wolf received,” she says. “The fast response, the coordination, how calm everybody was throughout those first critical minutes, the follow-up care — it was all absolutely amazing. The hospital should be very proud of this level of excellence.”

“Time Is Brain”
Stroke is the third leading cause of death in the United States. Treatment is most effective when given within the first hour after a stroke has occurred, so it’s important to recognize the symptoms and act quickly. If you suspect a stroke, call 911 immediately! EMS can begin vital treatment in the ambulance.

Stroke symptoms include:

  • Sudden numbness or weakness of the face,  arm or leg, especially on one side
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

How to Test for Stroke
The National Stroke Association  recommends the F.A.S.T. test as a way to quickly recognize and respond to stroke symptoms.

The F.A.S.T. Test

F = FACE     Ask the person to smile. Does one side of the face droop?
A = ARMS    Ask the person to raise both arms. Does one drift downward?
S = SPEECH    Ask the person to  repeat a simple  sentence. Is the speech slurred or strange?
T = TIME    If you observe any of  these signs, note the time and call 911 immediately.