Recognizing Stroke Patients and Emergency Medical Services Response

Submitted by: Bob Norton, Haddam Volunteer Fire Company Public Information Liaison

The Haddam Volunteer Fire Co. responds to all serious medical emergencies in town as the designated R-1 Responding Agency. Trucks are equipped with the latest of emergency medical equipment including large medical kits, oxygen delivery devices, cardiac defibrillators etc. Recently, a program to combat one of the leading causes of death and disability has been rolled out locally by our sponsor hospital, Middlesex Hospital.

Stroke is the third leading cause of death in Connecticut and it is a leading cause of disability. Risk factors include advanced age, high blood pressure, high cholesterol and prior history of stroke, diabetes and smoking.

There are two causes of strokes – a lack of blood supply to a part of the brain due to a clot, and excessive bleeding from a broken blood vessel. For the lack of blood supply type (ischemia), there are new and effective treatments, but they must be administered within a few hours of onset. To make sure that this happens, the CT Department of Public Health developed a plan that serves as a guideline to the general public, Emergency Medical Services (EMS) providers and hospitals. 

In order to make the system work, the stroke patient must receive EMS care and transport rapidly. Early recognition of the signs and symptoms is key. These signs and symptoms may be subtle, but can include face drooping, arm and/or leg weakness, slurred speech, vision problems, headache and dizziness.  Activating the EMS system by dialing 911 immediately is an important step to assisting the stroke victim. Frequently when these symptoms present themselves, there is an urge to wait an hour or two in the hopes symptoms will fade. That hour or two may make the difference whether or not the clot busting drugs can be administered. Call right away when these conditions are observed.

Valley Shore Emergency Communications will dispatch the Haddam Volunteer Fire Co., the Haddam Volunteer Ambulance Service, Inc. and paramedics from Middlesex Hospital. All of these EMS personnel are trained on performing a rapid neurological exam in a format to identify a candidate for thrombolytic therapy.  Questions will include the exact time of sign/symptom onset, any history of seizures or hemorrhagic (bleeding) stroke, any history of trauma or stroke within a 3 month period, any use of anticoagulant medications, knowledge of suspected pregnancy, no surgery in the past 14 days and no GI or urinary track bleeding in the previous 3 weeks. The patient will be asked to say “today is a sunny day,” will be asked to smile, and will be asked to hold both arms out straight for 10 seconds.  These physical tests help isolate the likelihood of a stroke. If the field exam confirms that conditions are satisfied, the patient will be transported directly to the closest facility accepting patients for the rapid stroke therapy. 

Middlesex Hospital was one of the first in Connecticut to be designated as a stroke center. As soon as the EMS units in the field have completed their exam, the hospital is notified and the request for a “Stroke Team Activation” is made.  Paramedics will initiate pre-hospital advanced life support as required.  

Upon arrival at the Emergency Department, a specialized team will perform a follow-up assessment and prepare for administering medications that have been shown to improve the stroke patient’s chances to return to a normal life.

The public can help by recognizing the signs and symptoms of stroke early, and without delay, alerting the EMS system by dialing 911. Just as when the heart stops beating, minutes count when parts of the brain have begun to go without oxygen. Members of the Fire Company ask that when in doubt, you dial 911 early.

More information on the activities of the Haddam Volunteer Fire Co. and ways you can get involved can be found on our website – www.HaddamFire.com.