Think F.A.S.T. – Treating a Stroke Takes a Team



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When it comes to treating stroke patients, you’ll hear doctors use the phrase “time is brain.” For every minute the brain is deprived of its blood supply, a patient can lose up to 2 million brain cells. Recognizing the signs is key to treatment and recovery; that’s why we need to think “F.A.S.T.” when someone is experiencing a stroke.

’F.A.S.T.’ stands for: Facial Drooping, Arm Weakness, Speech Difficulties and Time,” says Dr. Alvin Tang, Assistant Chief of Emergency Medicine for Kaiser Permanente, East Bay/Richmond. “It’s an easy mnemonic to remember when identifying the symptoms of stroke.”

 

What is a stroke?

A stroke occurs when blood flow to a portion of the brain is cut off due to a blood clot. If not treated quickly a stroke can lead to permanent brain damage and loss of function, or death. For example, if the area of your brain that controls your arm isn’t getting any blood, you’ll begin to experience weakness or loss of function in that arm. Many people confuse a stroke with a heart attack.

 

How does Kaiser’s stroke treatment differ from other hospitals?

We’ve developed a remarkable workflow for standardized stroke treatment among our Northern California Kaiser facilities, external agencies, and emergency responders. Using our integrated medical records system, we can facilitate the rapid treatment of stroke patients throughout our network.

For instance, if a patient needs to be transferred to our Redwood City facility, time in transit isn’t wasted. We use that time to access medical records, and notify each member of the team to prepare for the patient. Before the patient gets to the ER, his or her medical records are reviewed, and a plan of treatment is formulated.

Each member of the stroke team—techs, intake nurses, pharmacists, surgeons, neurologists, and tele-neurologists who help diagnose patients remotely—has a checklist or job aid. We are each responsible for executing our task(s) sequentially, meticulously and quickly. For example, we immediately weigh patients and send that information directly to the pharmacy. A pharmacist will begin to compound any drugs needed for treatment and we’ll have it shortly thereafter. It’s down to that level of detail.

Additionally, we continue to fine-tune our workflow by practicing regular stroke treatment simulations. With stroke patients, every second counts. The ER is hectic; it takes time and resources to coordinate these simulations, but we’ve found this training fosters collaboration among disciplines, and allows us to provide the best care in extreme and adverse conditions. This is how high acuity care has evolved – it’s all team based. We’ve made it part of our culture.

 

What is the treatment for strokes?

A drug call tPA (tissue plasminogen activator), has proven effective in a limited number of ischemic stroke patients (stroke caused by blood clots, not ruptures). Administered intravenously, tPA works by dissolving the clot to improve blood flow back to the affected area, but could potentially affect other areas of the body.

We are very cautious when using tPA. It’s a great medication for patients seen within the first 3-4 hours of their strokes. But, it also has life-threatening side effects and can cause massive hemorrhaging— so it’s only efficacious in a limited number of candidates. Beyond that, there are few treatments.

 

How has stroke care changed in the past decade?

tPA has been one key change; however at present only a select group of patients, about 20% of stroke victims, qualify for tPA treatment, which must be administered by a neurologist. But, outside of this drug, there are few available treatments.

That being said, our goal is to increase positive outcomes for every stroke patient who arrives in our ER.

 

What should a patient expect from Kaiser’s stroke care treatment?

Expect team-based, patient-centered, expedited treatment. The ER is rarely quiet – we cannot take a laissez-faire approach to stroke patients. Every second and every minute counts. Because of our simulations, we are able to perform like a well-oiled machine.

I follow up with all my patients. Many tell me they felt like they were being swarmed – it can be kind of scary to have 10 providers surrounding them, but they can be assured they’re receiving the best care possible.

 

Is there anything else you’d like to add about stroke?

If you, or someone you’re with is experiencing stroke symptoms – remember, think F.A.S.T.—immediately call 911. Do not drive yourself, or someone suffering from a stroke to the hospital. Your 911 call instigates all the protocols necessary to treat stroke victims upon their arrival to the ER. Remember, every second counts.

 

Kaiser Permanente, kp.org

 

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