When you’re in the middle of a medical emergency, it can be hard to think straight. Suddenly you find yourself making critical decisions quickly. You need someone by your side who can help you navigate through those difficult choices with confidence.

“You’re hearing what the doctors and nurses are saying, but at the same time, you’re not hearing it because you’re in the middle of a trauma,” says Joan McEvoy, whose husband, Tom, had a stroke earlier this year.

Joan’s medical training as a licensed practical nurse helped her respond immediately to the situation by calling the ambulance and reassuring her husband. But when she got to the hospital, her emotions as a wife took over. “I asked them not to talk to me like a nurse, but to talk to me like a layperson,” she says.

She and her entire family were thankful for the support they received at Lancaster General Hospital. “We’re a close family and everyone at LGH was there for us,” Joan says.

Since 1996 Lancaster General Hospital has had an established team (Code S) to immediately respond to, diagnose and treat stroke patients. The Joint Commission on Accreditation of Healthcare Organizations, a nonprofit organization, recently awarded Primary Stroke Center certification to Lancaster General Hospital after a thorough evaluation.

Having such a structured and efficient stroke program enables us to quickly care for the nearly 700 stroke and transient ischemic attack (TIA) patients who come to our emergency department each year. Venkatachalam Mangeshkumar, MD, Medical Director of the Lancaster General Stroke Center and member of Neurology and Stroke Associates, says that the keys to treating a stroke patient are speed and accuracy.

Time is particularly critical. A stroke or “brain attack” occurs when part of the brain is temporarily deprived of oxygen-rich blood. Disruption in blood flow is caused when a blood clot or piece of plaque blocks one of the vital blood vessels in the brain (ischemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

The brain needs a constant supply of oxygen and nutrients. Brain cells begin to die after just a few minutes without blood or oxygen. That’s why it’s so important to minimize the damage caused by a stroke.

When a stroke patient arrives at Lancaster General Hospital within a few hours of the onset of symptoms, a Code S is issued to alert medical personnel to immediately report to the emergency room.

“It’s capability and teamwork, not just availability of services, that make a great stroke program,” says Dr. Mangeskumar. “Emergency medicine physicians, neurologists, neurosurgeons, interventional radiologists, cardiologists, technicians, nurses and the emergency transport personnel all contribute to the prompt and efficient treatment of patients.”

After doctors identify the type of stroke, they can direct treatment. If less than three hours have passed since the stroke occurred, doctors may be able to administer Tissue Plasminogen Activator (tPA), a drug that helps dissolve the blood clot. LGH is also part of a research trial involving the NeuroFlow System. This new approach involves inserting a balloon catheter into the descending aorta to enhance blood flow to the brain. Dr. Mangeshkumar used this method to successfully treat Tom. This was possible only with the help of the cardiologists and dedicated angiography laboratory team. However, only a small percentage of stroke patients are candidates for either procedure. For most patients, doctors stabilize them medically, treat the cause of the stroke and manage risk factors such as high cholesterol or diabetes.

For hemorrhagic stroke patients, neurosurgeons may perform surgery to clip an aneurysm or to place a drainage catheter. Once their condition stabilizes, patients are evaluated to see if the stroke caused other damage and to offer additional treatments, if necessary.

In some cases, stroke causes paralysis and severe speech impairment. Fortunately for Tom, the impact was minimal. “Math was very hard at first. I just couldn’t figure out basic equations and I would get dates confused,” Tom recalls. He says his speech therapist was patient and dedicated to his recovery. Our speech/language pathologists not only help patients swallow safely, but also speak and understand language. They work with our occupational and physical therapists to develop individual plans for people like Tom to be able to regain all levels of function.

Lancaster General Stroke Center team members work with patients throughout their hospital stay to help them return to maximal function. Their commitment to stroke education and prevention involves public stroke awareness programs, a support group and community stroke screenings. They provide professional education for hospital staff, primary care physicians and emergency medical personnel to ensure continuing excellence in patient care.

One well-documented warning sign of stroke that the team educates people about is a TIA (transient ischemic attack). Also called a mini-stroke, a TIA occurs when a blood clot blocks an artery for a brief amount of time, temporarily causing stroke-like symptoms, generally less than 24 hours. TIAs indicate a strong likelihood of a risk for stroke. However, only 10 percent of strokes are preceded by TIAs. The other 90 percent of strokes are more difficult to predict.

It’s their unpredictability that makes them so dangerous. Strokes can strike anyone, at any age—40 percent happen to people under the age of 60 and women account for 61 percent of all stroke deaths. “If a stroke hurt, there would be no problem in getting people to the hospital quickly. But since it doesn’t necessarily hurt, we must continue our educational efforts. Only when people are aware of stroke symptoms and risk factors, can we hope to see them arriving earlier for treatment and also see a decline in stroke incidence,” says Kathy Morrison, BSN, RN, Stroke Program Coordinator.