Sep 23, 2018

The Golden Hour – Part I – Stroke Care

When it comes to Emergency Treatment, there is no more important phrase than “The Golden Hour”. This precious 60 minutes of time was first recognized and described by R. Adams Cowley, MD, at the University of Maryland Medical Center in Baltimore. From his personal experiences and observations in post-world war 2 Europe, and then in Baltimore in the 1960’s, Dr. Cowley recognized that the sooner trauma patients reached definitive care – particularly if they arrived within 60 minutes of being injured – the better their chance of survival.

As we fast forward to the care and treatment of other emergent disease processes, we can link the same term to stroke care, STEMI (heart attack) care and Trauma care.

In this first article, I would like to focus on “Stroke”. There is an important acronym to remember when thinking about the symptoms of a stroke. That acronym is F.A.S.T.:

  • F – Facial Drooping – Does one side of the face droop or is it numb? Ask the person to smile
  • A – Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downwards?
  • S – Speech Difficulty – Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like “the sky is blue.” Is the sentence repeated correctly?
  • T – Time to Call 9-1-1 – If the person shows any of these symptoms, even if they go away, call 9-1-1 and get them to the hospital immediately.

This is an easy way to quickly assess whether a higher level of care is needed. The first onset of symptoms is critical when dealing with a stroke as the reversal medication must be given within 3 hours of the initial onset of symptoms.

Among more than 100,000 patients treated at hospitals participating in the American Heart Association – Get with the Guidelines – Stroke Quality Improvement Program, 27.1 percent who arrived within the “Golden Hour” (one hour of symptom onset) were treated with the clot-busting drug tissue plasminogen inhibitor (t-PA). Of those who arrived between one and three hours of symptom onset 12.9 percent received the drug. T-PA is the only medication approved for use in ischemic stroke and again, it must be administered within 3 hours of the onset of symptoms.

Our local hospital has the specially trained Physicians and Nurses to care for the patient who presents with these symptoms. With the help of Dignity Healthcare, our local hospital also has access to a neurosurgeon who is on-call 24 hours per day and 7 days per week via telemedicine.

As you can see, the time it takes to drive down the canyon to a tertiary level of care may be the difference between complete recovery from a stroke and a significant, debilitating and irreversible deficit.