Emergency responders learn best ways to identify and treat stroke patients

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Strokes and TIA’s are common in Gilpin

By Lynn Volkens

“Remember…‘smile, speech, drop, drop, sensory, sensory, coordination,’” instructed D.J. Head, of Saint Anthony Hospital. “And try not to poke your eye out,” quipped one of the students when he realized he might be performing the procedure in a moving ambulance.

Three local emergency responders were squeezed into the back of an ambulance as Head guided them through an exercise designed to identify the symptoms of stroke. Thirty-five emergency responders – a mix of personnel from Gilpin Ambulance Authority (GAA), Black Hawk Fire Department (BHFD) and Clear Creek County had convened at the Black Hawk fire station for a Pre-Hospital Advance Stroke Life Support course that spanned two days and incorporated the expertise of three instructors. In the station’s weight room, BHFD’s Jamie Morgan was teaching another group the same exercise, as was Rich Buchanan of South Metro Fire Rescue Authority, for a group in the station classroom. Morgan and GAA Director, Zane Laubhan, later pointed out that many of the same directions to emergency responders could be helpful to the average citizen in the event a family member or friend was having a stroke. Here’s the drill, in abbreviated form for the average citizen:

  1. Ask the afflicted person to “Show me your teeth,” for a big smile – if one side of the face is drooping, that’s a sign of stroke.
  2. Ask the afflicted person to repeat a well-known phrase (the instructors were using, “You can’t teach an old dog new tricks.”) Slurred speech is a sign of stroke.
  3. Ask the afflicted person to close his/her eyes and raise both arms to the same height. If one arm “drifts” or can’t be lifted to the same height – that’s a sign of stroke.

Remember it as social behavior, as in “Smile, Talk and Wave,” or think “FAST,” which stands for Face, Arms, Speech, and Time (as in “time to call 911”). Emergency responders hope that one of these phrases will work to help people remember stroke symptoms, the same way “Stop, Drop and Roll” is used when a person’s clothing catches fire. If stroke is suspected, they recommend keeping the afflicted person calm and sitting upright, do not give aspirin, do be prepared to start CPR, and DO call 911! The dispatcher who answers will know which questions to ask and can offer guidance from there.

“We run a lot of strokes up here,” Laubhan said, estimating as many as 30 stroke or Transient Ischemic Attack (TIA, sometimes called “mini-stroke”) cases per year. It’s more likely that the ambulance will be called for people visiting the casinos than it is for local residents, he lamented. Why is that? “Out in the county, people call a neighbor to get an opinion,” he said, adding that then they probably have a family member or friend drive them to an emergency room. Laubhan said he has heard that some residents think the ambulance won’t take them when it’s only a suspected stroke or TIA. Not true. “Call us!” he pleads, “Give us a chance to save your brain.”

The training these local emergency responders completed will go a long way in doing just that. They went far beyond the Smile, Talk and Wave test. Hence the “smile, speech, drop, drop…” memory help they were using. As EMT’s, paramedics and firefighters took turns playing patient, the instructors drilled their colleagues on several more ways to test for deficiencies in a patient’s visual field, motor strength, sensory ability, coordination and mental function. The volunteer “patients” complied, stating their names and ages, reciting “Can’t teach an old dog…,” looking left and right, closing their eyes to lift their arms, their left legs, then their right, identifying which wrist was being touched and if the touch felt the same when done to the other wrist (or if it could be felt at all), touching finger to nose – “Now do that with your other hand,” (not one got poked in the eye) and sliding heel to shin – “Can you do that with your other leg?” as the instructors put each responder through the paces. By the time they get to these advanced assessments, it’s likely the patient will be in the back of the ambulance en route to one of the hospital stroke centers. These pre-hospital assessments are crucial.

Ambulance transport time from parts of Gilpin is 50 minutes. “Assessment skills and communication save lives,” Buchanan told the emergency responders during a Major Stroke Syndromes lecture. It’s different from ten years ago, he said. Now, 80% of stroke victims get better, based on where the stroke occurs in the brain and treatment. Buchanan tipped the emergency responders to a cell phone application that they can use to input stroke assessment information. The “app” covers all the bases and organizes the data so that it can be easily and quickly relayed to hospital staff. “You can have a CT scan and a neurosurgeon waiting and ready to go when you get there,” he told them. Emergency responders learned the signs that differentiate strokes occurring in the cerebellum, cerebral sub cortex, cortex, cerebrum and brain stem. That helps determine treatment. Some conditions like seizures, hypoglycemia, migraine, tumor, abscess and subdural hematoma (a brain bleed), can mimic stroke symptoms, so emergency responders learned the tips to differentiate those, too.

The dedicated stroke training provided by GAA to area emergency responders gives local residents and visitors to Gilpin County a better chance of surviving a stroke with the least impairment. Instructors used lectures with projected visual diagrams, case-based video scenarios and drilled the responders in numerous break-out hands-on sessions. Then there was a test, plus a follow-up question and answer session. All to make sure emergency responders will know a stroke when they see it, can get an indication of its location in the brain, and can best prepare hospital personnel for the patient’s arrival. Training isn’t nearly as involved or as tough for the average Gilpinite, but it can be just as crucial, so don’t forget the three easy steps: “Smile, Talk, and Wave.” Then, call 911.

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