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Group mounts
By Helen Altonn
‘ambitious’ effort
to reduce strokes,
increase awareness
Star-BulletinA medical group is working to improve prevention and treatment of strokes, which killed more than 600 islanders last year.
Hawaii's Operation Stroke Committee is part of an American Heart Association effort to decrease death and disability from stroke by 25 percent in eight years.
"It's a very ambitious goal," said Dr. Cherylee Chang, neurologist and medical director of the Queen's Medical Center's Neuroscience Institute/Stroke Center.
The campaign involves public education to prevent and recognize strokes, or brain attacks, as well as changes in the care system, she said.
Chang heads the committee with Dr. Don Fancher, medical director of the Hawaii State Emergency Medical Services System.
Fancher said Hawaii was one of the first states to implement a paramedic program known as mobile intensive care technician, with training and equipment needed for stroke patients in emergency rooms.
As a result, he said, "Hawaii has excellent care for stroke patients in the EMS system. All we have to do is activate it sooner. That's the key thing -- people's awareness, when they think they're having strange neurological symptoms, numbness or weakness. As soon as they activate the 911 system, they receive very good care."
Chang said strokes are the No. 1 cause of adult disabilities in the United States and the third leading cause of death.
About 3,000 Hawaii residents suffer from strokes annually, she said, explaining this is just an estimate because the state only collects death numbers.
About 25 percent to 30 percent die; about 30 percent can resume some normal activities, and the rest are disabled, she said.
Ten years ago, Chang said, stroke patients "were the last ones treated in ER because there was nothing you could do for them." Major advances in medications include a drug known as t-PA (tissue plasminogen activator), which has revolutionized stroke treatment for one group of patients, Chang said.
It is meant to help those with ischemic stroke, which occurs when blood vessels to the brain become clogged, cutting off blood flow to brain cells. It permits the blood to flow through the blocked vessel.
But it must be given within three hours after the symptoms start. "If you wait too long, you are brain dead," Chang said.
Another type of stroke is the hemorrhagic or bleeding stroke, which occurs when a blood vessel ruptures in or near the brain.
Chang said a bleeding stroke is like a sprinkler system that breaks open and floods the lawn. The ischemic stroke is like a sprinkler system with dirt-plugged pipes so water can't get to the lawn, which dies, she said.
About 15 percent of mainland strokes are bleeding and 85 percent ischemic, according to national studies, Chang said.
It isn't clear why, but Hawaii's ratio is different, she said -- about 30 percent hemorrhagic and 70 percent ischemic.
In a committee survey of 252 residents to see how much they know about strokes, Chang said 41 percent couldn't recognize any symptoms and only 64 percent knew things that could prevent a stroke.
"Only 35 percent, even though we were trying to help with education, had heard about stroke in the last year."
She said a lot of education is needed, "from patients all the way through hospitals and even rehab." Families should be educated in case one member is present while another is having a stroke, she said.
The committee also found three of the 12 hospitals on Oahu and five of seven on the neighbor islands lacked written procedures or protocols to diagnose and treat strokes.
In an article in the Journal of the American Medical Association, Duke University medical researchers said stroke remains a common disorder despite significant progress in diagnosis, treatment and prevention. The lifetime costs exceed $90,000 per patient for ischemic stroke and more than $225,000 for bleeding stroke, they said.
The researchers recommended establishing primary stroke centers to improve care of stroke patients, similar to trauma centers.
Chang said there has been talk for years about whether some places should be designated as stroke centers, or whether there should be a comprehensive stroke center. "Hospitals obviously are somewhat resistant to this idea."
Fancher said he feels every Hawaii hospital should be able to care for stroke patients initially because of the short time frame to administer t-PA, the remote location of many hospitals and traffic obstacles in trying to get to a hospital equipped to deal with stroke.
For information, call the American Heart Association, 538-7021, or visit the Web site of the AHA's American Stroke Association: http://www.strokeassociation.org/
Warning signs of stroke:
Sudden weakness in an arm, hand or leg.
To prevent a stroke:
Source: American Heart Association
