'This is 911. What is your emergency?' How prepared are you for a medical emergency?

[Kmart4321]

I had not seen that acronym yet but it is a good one for educating the public. No doubt it will work it's way north as the American Heart Assoc, AHA and the Heart and Stroke Foundation of Canada, H&SFC, often exchange ideas, campaigns and the like to educate the public at large.

I can not stress enough how important it was that you activated advanced care. In the jurisdiction where I work, we have 210 minutes from the time of onset of symptoms to get them to the door of the Stroke Centre. The hospital then has 60 mins to assess, CT scan, interpret findings and administer drugs before time runs out. Research has shown that beyond 270 mins, drugs are of no benefit. You got the ball rolling to definitive care.
It is quite possible that the individual would have been medi-vac'd to another facility via rotary wing aircraft depending on the capabilities of the facility EMS transported him to. All this takes time but your actions saved precious minutes.

It is fairly rare for someone that age, in my experience to have an ischemic event. More often than not, they have tended to be haemorrhagic CVA's but their clinical presentation is often much worse at the outset.

A CVA or "stroke" is a life threatening emergency. The brain controls all other functions in the body and when it is interrupted of the two things it requires, oxygen and glucose, bad things begin to happen quite quickly.

As for the medic, maybe a little bit of what I like to call "pager panic". I see it in new partners all the time, and their stress is sometimes released on those at the scene unfortunately. One thing I will tell them and Paramedic students "This is not your emergency. We have to be the ray of warm sun that shines through the storm clouds of emotions that is circling. Do not allow yourself to become a storm cloud"

"A brain attack" is an interruption of blood supply to the brain tissue, just like a "heart attack" interrupts blood flow to the heart muscle. Same but different and both can be life threatening.

Rest assured you gave this guy the best chance he had of recovery based on where he was geographically, your knowledge and tools at hand.

Cheers

---------- Post added March 25th, 2015 at 07:55 AM ----------

Stroke mnemonics and such are interesting fodder for discussion, but I think that another key thing for lay people to remember is that the role of Emergency First Response is pretty straightforward: activate professional emergency medical services and stabilize/protect the patient until EMS arrives.

EFR training includes simple situation/sign/symptom-dependent things that should be considered and actions that should be taken. However, beyond simple "don't move them if it might be a spinal injury" or "it might be shock, get a blanket" sort of things there is no reason for - or value in - a lay EFR spending valuable time on DDx.

1. The training we receive is not sufficient to enable us to do so effectively
2. We're not trained to - and shouldn't - do anything different based on whatever Dx we might come up with anyway

When time is of the essence - and you might not be qualified to even determine THAT accurately - don't delay care or try to determine who to call based on results of amateur field diagnostics. Call 911, stabilize the victim, and render primary/secondary care until EMS arrives.

Beyond the fact that it's the right thing to do medically, you're also better protected legally if you stay within the scope of your training/expertise.

While I agree to a point, the public at large needs to know what a stroke looks like and look for the signs. If they think the signs are there, call 911. In my 14 1/2 years as a Paramedic, I have been to countless calls where the following was said to me on arrival "Mrs. So and So is not acting right. She won't talk to us and won't get up to walk. That is unusual for her. She was fine at Breakfast." It is now 4 pm and well outside the time frame for stroke treatment.

Learn the signs and symptoms of a stroke. Make sure your family knows. And make damn sure they know to call 911 if they have any inkling that it may be. I would much rather it be nothing than arrive 6 hours later and have no options in the way of how I treat/transport the patient.

Cheers

 

[RJP]

While I agree to a point, the public at large needs to know what a stroke looks like and look for the signs. If they think the signs are there, call 911. In my 14 1/2 years as a Paramedic, I have been to countless calls where the following was said to me on arrival "Mrs. So and So is not acting right. She won't talk to us and won't get up to walk. That is unusual for her. She was fine at Breakfast." It is now 4 pm and well outside the time frame for stroke treatment.

Learn the signs and symptoms of a stroke. Make sure your family knows. And make damn sure they know to call 911 if they have any inkling that it may be. I would much rather it be nothing than arrive 6 hours later and have no options in the way of how I treat/transport the patient.

Cheers

While it sounds semantic, I personally feel there's an important difference between "recognizing the signs and symptoms of stroke" and "diagnosing a stroke based on signs and symptoms."

The plethora of mnemonic devices may well be counterproductive if they become paralyzing in and of itself. Which symptoms? Was that acronym FAST, or FACE, or FACT? What did the A stand for? Ughhh!

From a pure communications standpoint it is patently absurd that the "T" in the mnemonic FAST stands for time and tells you to "call 911 immediately." So why then, does that point come at the END of the mnemonic? Someone somewhere along the way was a bit too concerned with being clever, as the risk of sacrificing clarity.

My mother in law is 12 yrs post-stroke. 12 years of complete disability, including the last five in a nursing home. My father-in-law is now disabled having hurt his back repeatedly while caring for her before she went into the nursing home. Because of his loss of balance due to his back, he's been falling and hitting his head a lot the last few years. We only recently found this out because he finally broke his hip and had to be hospitalized. His recent EEG and MRI revealed multiple focal lesions consistent with repeated head injuries. He's now homebound.

Sadly (or fortunately) we'll never know how much of this was due to the fact that my father-in-law spent way too long trying to "diagnose" my mother-in-law that morning twelve years ago.

Seems that he didn't want "to be wrong" about whether or not it was a stroke. He got out a book that said one thing. Tried to remember what the Consumer Reports Health newsletter said. Looked up something online that said something else. Asked her what else she was experiencing symptom-wise, etc. Did her arm really drift down that much? Try it again. Now she's just being obstinate?!?

At initial onset she had subtle, but clear signs that caused him to think "stroke" right off the bat. By the time "he was sure" and called 911 she was pretty badly off. By the time EMS got there she was conscious but completely non-responsive. By the time she got to the hospital, it was too late for the stroke team to do much.

Run through all the mnemonics you want... after you call 911.

 

[Dnaber]

Netdoc, good on you for being the person you are. In this day and age many folks would just record on their cell phones this poor man dying and not lend assistance. Thanks

 

[Storker]

The real take-home message here isn't the symptoms of stroke. It's the prompt and proper reaction to a possible medical emergency. These days, far too many are afraid of being involved, afraid of doing something wrong - although, as has been said, doing something is usually better than doing nothing - get paralyzed by the situation, or are just plain dumb.

I've been in a few situations during my life where I've responded to a possible emergency. Fortunately, only one of these situations was as serious as Netdoc's. That was a fatal traffic accident, and the situation was bleedin' obvious (pun definitely not intended). Still, one of the things I had to do at that time was to prevent another onlooker from moving the injured person while we were waiting for the paramedics, due to the great risk of spinal damage to the victim (it didn't matter, though, because he died a few hours later, but we didn't know that at the time). At the time, he had a pulse, he was breathing, and there were no serious hemorrhage. Nothing more we could - or should! - do.

What's important is to respond. Check on the person, call emergency services (easy these days, when everyone carries a cell phone, not so much back when I was younger), provide information about your name, place, and situation, be there until the paramedics arrive. But respond. Take action. Get involved. How would you feel if you found out that a person had died, and you could have made a difference? That is what Netdoc did right, and that is where he made a difference. Everything else is secondary.

First aid isn't rocket science. Life-saving first aid is securing free airways, CPR if needed, stopping serious hemorrhage, avoiding circulatory shock, calming panicked or shocked people and calling paramedics. Anything beyond that is the paramedics' and the doctors' domain. And don't move an unconscious person unless it's really, really needed. There may be a spinal injury.

 

[Imla]

GOOD JOB!!!

I am a dispatch nurse at the norwegian equivalent to 911. (Ours is 113)
From what I have discerned we normally give a lot more advice concerning first aid.
However... Like the Paramedic that answered you: VERY GOOD WORK!

You recognized a problem. You called the right agency to help.
I would not have given you grief over moving the person. Oftentimes showing understanding and helping can cause less strain on the sick/injured than if they need to struggle themselves.

However, from the "other side of the phone", I can tell you, this does sound like one of those classic strokecalls we get. Depending on which area of the brain is hit, the symptoms will be different.

It is normal to react after something like this. Talk to your family. Talk to friends. If you need more info, ring your local GP.
But in my opinion.... You're my hero of the day! Time IS brain! Time is extremely precious when limiting brain damage!

Thank you for "giving a damn". Thank you for being there for the poor wife. Thank you for calling 911.

Lots of greetings from 113 Norway!

 

[Storker]

I am a dispatch nurse at the norwegian equivalent to 911. (Ours is 113)

But 112 (the European standard emergency number) will get me through to you if necessary, right?

(Just nitpicking here. We DO have three different emergency numbers - 110 for fire, 113 for medical emergencies and 112 for police/general emergencies - but 112 dispatch is supposed to transfer you to the correct service if that's the only one you're able to remember in the heat of the moment. And (except for the UK?) 112 is the general emergency number for all of Europe)

 

[Imla]

But 112 (the European standard emergency number) will get me through to you if necessary, right?

(Just nitpicking here. We DO have three different emergency numbers - 110 for fire, 113 for medical emergencies and 112 for police/general emergencies - but 112 dispatch is supposed to transfer you to the correct service if that's the only one you're able to remember in the heat of the moment. And (except for the UK?) 112 is the general emergency number for all of Europe)

Both 112, 911 (Yes...), 110 and 113 will get you there... The first to will get you to Police dispatch, the third to Fire and the last one to Medical Emergencies.
You can even pull your simcard and get in a call to the Police.

 

[Storker]

Both 112, 911 (Yes...), 110 and 113 will get you there...

I didn't know about 911. Cool. Makes sense,tho'.

 

[JohnnyC]

You did a great job NetDoc. It's easy to second guess things after the fact, but you did great, you got the guy the care he needed. People can nitpick all day over minutia, but I guarantee he'd be in a worse off place had you not intervened.

I got tired of trying to remember acronyms and such, so I started carrying a little laminated copy of the USN post-dive neuro exam, slate sized for my wetnotes, and cut down and pocket sized in my wallet. I'm not going to do a full exam on somebody, but even a quick glance resets your OODA loop into the situation. It happens to have lots of correlation to stroke symptoms, so it's beneficial for more than just diving, and any trauma is usually more apparent. Any small reference that pushes you into the mindset is good to have. No need to get out a grease pencil and fill out a 9-line, but even a quick skim prepares you.

 

[The Chairman]

KMart and Ray,

This reminds me of something Reggie Ross taught me during my ITC. "Look at your student carefully. If they don't look like a diver, figure out why!" and then he always kept talking about the 'Spidey Sense' you needed to develop as an instructor. When I saw Fred and Mary, they just didn't look like normal tourists. They were obviously stressing and him being on the ground at that angle was all wrong. While I had suspicions that this was a stroke, I KNEW that they needed medical help beyond my meager abilities.

In Florida it cost you nothing, zero and nada for an ambulance to arrive at your door and assess you. They only get to charge if they administer anything other than advice and/or transport you to the nearest hospital. If in doubt, call it in. Denial is not just another river in Egypt, but rather an epidemic here in the USA. Mind you, Mary was not in denial, I don't think. But this event blind sided her and she was confused as I've ever seen. Confusion and denial are pretty debilitating. Pick a course of action and follow it through.

As for being the 'ray of hope', I think a lot of first responders miss how important that is. I remember as a kid in Boy Scouts a Patrol Leader telling his buddy not to freak out about the cut on his finger, because if he goes into shock he might very well die. It was frickin' hilarious to see this poor kid's face go white with real fear at that point. The Patrol Leader was teased incessantly about his faux pax as long as he was a part of Troop 25. Be a part of the solution and never add to the problem.