Addressing the Stroke Epidemic: Building Stroke Ready Hospitals

The biggest misconception among people is that a stroke is a disease of the elderly, but the fact is that 10-15% of all types of strokes actually occur in patients below the age of 45. According to Dr. Vikram Huded, Head of Neuro-intervention and Stroke at Narayana Health City, Bangalore the occurrence of strokes is one of the most leading causes of morbidity and mortality in our country. Since 1996, there has been a FDA approved drug for the treatment of acute ischemic stroke. However, only less than 1% of all stroke patients in our country receive this treatment.

Since early 2015, there have been further developments in the management of acute ischemic stroke through endovascular treatment procedures. This treatment attempts to mechanically remove a blockage from the blood vessel using a stent retriever. Around 60% of people who have undergone this treatment have experienced excellent recovery in just three months of time. Another treatment called clot buster treatment ensures that the patient receives the necessary medication within 4.5 hours from the onset of symptoms. In the case of endovascular treatment, it should be initiated within 6 hours after ruling out contraindications.

Sometimes there could be a delay in diagnosis and treatment due to certain reasons such as: a lack of awareness among doctors on the existence of the latest treatments, a lack of awareness about the symptoms of stroke among patients, the need to reach stroke ready hospitals on time, and finally, the lack of efficient facilities in certain hospitals. In order to achieve best results, both treatments mentioned above should be initiated immediately post diagnosis, leaving no room for delay.

Let’s take a look at the symptoms of stroke.

  • Sudden onset drooping of angle of mouth
  • Sudden slurring of speech
  • Sudden difficulty in speaking or understanding
  • Sudden weakness one side of the body
  • Sudden numbness of one side of the body
  • Sudden onset of loss of consciousness

The most common symptoms of stroke can be remembered by the acronym FAST which stands for drooping of Face, weakness of the Arm, slurring of Speech, and the Time taken to rush a patient to stroke ready hospitals. This disease directly affects the brain. Hospitals therefore need to be efficient or well equipped to handle stroke emergency cases to save patients from losing time.  It is important to remember that every second lost results in the death of 30,000 brain cells.

This makes it imperative for hospitals to ensure that they’re stroke ready. The minimum criteria for ensuring this are as follows:

  • Deploy a dedicated stroke-focused program
  • Ensure staffing with qualified medical professionals trained in stroke care
  • Provide a 24/7 service platform to perform rapid diagnostic and laboratory testing
  • Establish the ability to administer intravenous clot-busting medications to eligible patients
  • Use transfer protocols to facilities that provide comprehensive stroke services

The biggest challenge for the medical industry is to create more awareness about stroke ready hospitals. Most patients are clueless about where to go even when they recognise the symptoms of a stroke.

Hospitals such as the Narayana Health Network have a dedicated stroke team comprising of a stroke nurse, trained emergency medical doctors, duty neurology doctors and radiologists who are backed by stroke fellows and interventional neurologist. It is important for patients to receive treatment within one hour of arrival in the emergency department. Patients can be thrombolysed using the clot buster drug as well as using endovascular treatment which includes clinical assessment, imaging, blood tests and commencement of the treatment.

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