Most African Americans call a friend or relative instead of 911 when they have symptoms of a stroke, potentially delaying arrival at a hospital and access to lifesaving treatment, according to a new study.
The findings, published online Thursday in the journal Stroke, offer a clue for researchers seeking to understand the disparities in stroke treatment between blacks and whites. The findings have particular significance for predominantly black urban populations, researchers said. The study, by researchers at Georgetown University Medical Center, included interviews with stroke patients at Washington Hospital Center, the Washington region’s largest hospital.
Researchers said the findings have already helped officials tailor educational materialsfor sessions that researchers are conducting in churches and health fairs across the District. The materials include emphasis on immediately calling 911 and address not just potential stroke victims but also children, siblings and friends.
Strokes are the third-leading cause of death in the United States. About 795,000 Americans each year suffer a new or recurrent stroke, meaning on average, someone has one every 40 seconds, according to the American Stroke Association.
A stroke occurs when a blood vessel in or leading to the brain bursts or is blocked by a blood clot, depriving the brain of the oxygen it needs. Depending on the severity of the stroke, immobility or paralysis might occur.
In the United States, the rate of first strokes in African Americans is almost double that of whites, researchers say, because of higher incidences of risk factors such as high blood pressure and obesity. And strokes tend to occur earlier in life for African Americans. Studies have also shown that fewer blacks than whites receive a treatment that breaks up the blood clot in the brain causing the stroke, in part because blacks are not getting to the hospital in time.
‘Drop everything and call’Someone having a stroke “needs to drop everything and call 911 right now,” said Amie Hsia, the study’s lead author and medical director of the Washington Hospital Center’s Stroke Center. Patients arrive at the hospital faster by ambulance and are evaluated faster, she said.
“Every minute, more brain cells die,” said Chelsea Kidwell, director of Georgetown University’s Stroke Center, which conducted the research. Even though the window for treatment can be up to 41 / 2 hours for some people, “the time between hitting the emergency room door and getting the medication should be under 60 minutes,” she said.
Before the medication can be given, lab tests and brain scans need to be performed to determine whether the patient’s stroke results from a blockage, like a clogged pipe, or is more like a burst pipe, where a blood vessel has split open. The medication known as tPA, or tissue plasminogen activator, works like Drano but is only effective on the blockage type of strokes, Kidwell said. The treatment can significantly reduce the effects of a stroke and reduce permanent disability.
he American Heart Association and the Congressional Black Caucus announced a campaign Thursday to encourage healthy behavior and increase awareness of what to do in a stroke emergency.
Researchers interviewed 230 African Americans in neighborhoods around Washington Hospital Center in 2007 and 2008 and found nearly 90 percent said they would call 911 first if faced with a hypothetical stroke. But when researchers interviewed 100 acute stroke patients or those who accompanied them to the hospital, they found “an interesting disconnect,” Hsia said.
Seventy-five percent said they called someone else first instead of 911 when they realized something was wrong. Eighty-nine percent reported significant delay in seeking medical attention, and almost half said the reason for the delay was thinking that the symptoms were not serious or would resolve on their own.
What was most striking, Hsia said, was that “people were not aware there was time-sensitive, clot-busting medication we can give for stroke.”
Of those who did call 911 for an ambulance, 25 percent said they did so because they thought it would be faster, while 35 percent said they had no other transportation option, the study found.
Although stroke patients were asked whether concerns about the District’s emergency medical response system was a reason for not calling 911, Hsia said it was not a primary reason people gave. That concern surfaced in later interviews with focus groups, where respondents also spoke of fear that ambulances might not find their way to a particular neighborhood quickly enough, embarrassment if an ambulance showed up and concern about the cost of emergency services, she said.
As part of an ongoing $7.5 million grant to Georgetown University Medical Center to address disparities in stroke care affecting African Americans in Washington, the stroke center has been working with emergency responders and designated stroke-certified hospitals — Georgetown, Washington Hospital Center and George Washington University Hospital — to improve care. The grant is from the National Institute of Neurological Disorders and Stroke and the National Institute on Minority Health and Health Disparities, both part of the National Institutes of Health.
Response deficiencies
The death of a retired New York Times journalist in 2006, who was hit in the head with a pipe but assessed as drunk by responders, highlighted deficiencies in the city’s emergency medical response system. Another incident last year involved a 2-year-old child in Southeast Washington who was not immediately taken to the hospital by emergency responders. After a 911 response to the same address nine hours later, she was taken to Children’s National Medical Center. She died the next day; D.C. police are investigating the death.
The D.C. Fire and Emergency Medical Services Department handles about 160,000 emergency calls a year, according to spokesman Pete Piringer. About 80 percent of the calls are medical in nature, and slightly more than 90,000 transports to hospitals were made last year.
Piringer did not have a gender, ethnic or cultural breakdown of calls for medical services. But with a District population of about 600,000, “it seems there may not be too much reluctance for most anyone to call 911 in stroke cases and most other situations, but possibly a lack of awareness on the signs and symptoms and when to call when someone suffers a stroke or signs of stroke,” he wrote in an e-mail.
When Greenbelt resident Hasha Riley, who is black, suffered a stroke in 2005, she called her mother in New Jersey, not 911. Riley, then 35, considered herself to be in good health. At 5-foot-4, she weighed 110 pounds. She woke up with her right arm and hand completely numb and was unable to swallow or talk properly, all symptoms of stroke. Right away, her mother knew something was wrong and called a friend who lived near Riley. The friend rushed over and called 911.
Riley thinks about 10 minutes lapsed before an ambulance arrived. She made a full recovery. She didn’t call 911, she said, because “I was afraid they wouldn’t understand me.”
She has since learned that time is critical. Two years ago, when she was a temporary D.C. government worker, she suffered a mini-stroke in the office. She immediately asked a co-worker to call for emergency help.
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