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For strokes, hospitals with the latest treatments are the key. Ambulances do not always go there



More than 140,000 Americans die each year from a stroke. If you get to the best hospital as quickly as possible after a stroke, you will improve your chances of survival. And where an ambulance drives, one could rely on the law of the state.

Contrary to state regulations for accident victims who uniformly require first responders to bring severely injured patients to the most advanced available trauma unit, state guidelines for stroke patients vary. [19659003] Most state regulations direct paramedics to stroke with the closest hospital, regardless of the severity of the attack. And some states limit paramedics to bringing stroke patients to hospitals within state borders.

However, most of these rules came before the advent of thrombectomy surgery to remove blood clots from the brain. New research shows that the procedure offers patients with a major stroke a significantly better chance of survival without impairment.

As a result, about half of the states are working to change their EMS rules and policies to ensure that the most critical patients operate as quickly as possible. Neurological professionals recommend that if a comprehensive stroke unit is traveling within a two-hour flight or drive, then severe stroke patients should be transported there, even if a subordinate stroke unit is closer.

In January, Ohio joined Arizona, Arizona. Colorado, Rhode Island, Tennessee and Virginia demanded that paramedics transport patients with a severe stroke directly to a hospital with a comprehensive stroke center that is approved for thrombectomy, provided that it can be achieved within a specified period of time. 1

9659007] Florida, Massachusetts and New York are nearing the adoption of similar updates for their emergency response to stroke.

Legally prescribed stroke protocols do not require paramedics in Florida, Georgia, Indiana and Oklahoma to transport severe stroke patients directly to a patient hospital that can perform thrombectomies. However, some paramedics in these states use a free smartphone app called Fast-ED to screen stroke patients for severity, find a comprehensive stroke unit, notify the unit, and get there as soon as possible.

Other Local and Regional Collaborative Efforts Hospitals and paramedics ensure that patients are brought to the most appropriate hospital. Across the country, however, emergency beating protocols are a mess.

"When a person is shot dead in a country, the first responders know where the trauma unit is located. You will bypass a small community hospital and go straight to the Trauma Center. The same must be done for stroke victims, "said Adam Arthur, a neurosurgeon at the Semmes Murphey Clinic in Memphis.

However, not everyone believes switching to more stroke centers is of paramount importance

Sallyann Coleman King, stroke expert in The Centers for Disease Control and Prevention said it was not practical to put each patient in a comprehensive stroke center, "even if we had all the money and resources to turn all the centers into a comprehensive stroke center," she said. "It just does not make sense."

First, the public needs to know if 911 needs to be called if someone's there. You've had a stroke, she said.

About half of all stroke patients get away with it An ambulance in a hospital You are taken by a friend or neighbor or taken a taxi. "We ve Find out that stroke ambulance starts in the ambulance, "said King.

"It makes sense to create a system of care where the community and the patients know and call the signs and symptoms of a stroke 911," she said. "The EMS system is ready to collect the information it needs To evaluate the patient and to bring him to a suitable facility to treat his stroke as best as possible. "

The need for new emergency stroke protocols stems from the results of recent clinical trials Thrombectomies are highly effective in the prevention of stroke and stroke Limiting disabilities.

In 2004, the Food and Drug Administration approved the first device for manual thrombectomy, in which a catheter is inserted into an artery of the groin and passed through the neck until it reaches an arterial blood clot in the brain Then the artery is stretched and the clot with a special device taken at the end of the catheter and removed.

It took eleven years to improve the design of the device and demonstrate the effectiveness of stroke surgery.

Until 2015 Surgery has been performed on thousands of patients and catheters and instruments for the removal of arterial clots have improved. Recently, two groundbreaking clinical trials – one in Germany and one in the Netherlands – have proven their effectiveness for broader use.

Increasingly, paramedics and emergency physicians recognized that thrombectomy surgery may be more important for patients with blood clots in large cerebral arteries. A lower level of treatment, e.g. B. anticoagulant drugs, which could be administered faster in many cases.

A 2018 study, conducted by researchers at the Grady Memorial Hospital in Atlanta and the University of Pittsburgh Medical Center, showed a severe stroke patients who underwent a thrombectomy within 24 hours of a stroke survived without the brain damage significantly lower than was the case with conventional treatments.

Until recently, however, almost all first responders brought stroke patients to the nearest hospital. In general, emergency physicians would decide if patients should be transferred to the ground or in the air in a comprehensive system Troke unit for a thrombectomy.

A study by Duke University researchers published in January showed that patients who were taken directly to a hospital where a thrombectomy can be performed had better outcomes than those who were first taken to a local hospital and later to a hospital a hospital were brought to a comprehensive stroke center.

A dose of anticoagulant medication costs more than $ 6,000. Mechanical thrombectomy costs about twice as much.

Stroke mortality rates vary from state to state. In some states, laws and regulations are passed to improve the chances of surviving stroke victims by ensuring that the ambulance service brings patients to the nearest and most appropriate stroke center.

The vast majority of strokes, nearly 800,000 a year in the United States of America United States are ischemic strokes, in which a blood clot is involved in an artery in the brain. About 11 percent of them are severe and have clots in large arteries that interrupt significant blood flow. These patients could benefit from thrombectomy.

However, less than 10 percent of eligible patients receive surgery, according to the Society of NeuroInterventional Surgery, an international scientific organization committed to improving public access to thrombectomies.

In a series of guidelines for emergency procedures for stroke victims, the American Heart Association wrote: "If multiple [stroke] -capable hospital options exist in a particular geographic region, the benefit of bypassing the nearest hospital is to bypass the patient Bringing Patients to Higher Rates The extent of stroke care, including mechanical thrombectomy, is uncertain. Further research is needed.

However, after an outcry from neurosurgeons who were familiar with the procedure and research behind it, the organization withdrew the guidelines. A representative of the AHA wrote in an email to Stateline that the organization is working on an update.

Strokes and related heart disease are the world's leading cause of death, according to the world in 2016, there were a total of 15.2 million deaths Health Organization.

The fifth leading cause of death in the United States, strokes are also a major cause of disability in adults. The condition, sometimes referred to as a "cerebral infarction," occurs every 40 seconds, according to CDC.

Thanks to improved nutrition, increased physical activity, and reduced smoking, the incidence of stroke in the United States has been falling since the 1970s, according to an AHA statement. At the same time, survival rates have increased.

In patients who survive a severe stroke, about 40 percent of disabilities that require special treatment sometimes suffer for life. The age and severity of a stroke determine how a person recovers after a stroke.

According to the Society of NeuroInterventional Surgery, 65 percent of patients who are brought directly to a comprehensive stroke center without long-term disabilities, 42 percent of those were taken to the nearest hospital with a less advanced stroke center.

Proponents predict that the more hospitals will develop the expertise to conduct thrombectomies, and the more patients will have access to surgery, the disability-free survival rates stroke victims will even increase.

– Stateline

Christine Vestal is a reporter for Stateline, an initiative of the Pew Charitable Trusts.

Correction: This report was updated by Stateline to remove false information that actor Luke Perry was taken to the Cedars-Sinai Medical Center in the ambulance after a February 27 stroke. Hospital officials said he had not been taken there.