March/April - West Virginia State Medical Association

| Scientific Article
included a call to 911. The 911 call
was most often (60%) placed by
family members. 5 Every minute
between the time the patient was
last seen neurologically normal and
arrival at the emergency department
for treatment potentially increases
both the amount of irreversible
brain damage and the probability
that the patient will be ineligible for
various thrombolytic treatments due
to treatment time window limits.
Therefore, it is critically important
that the individuals receiving the
call not only recognize that the
person may be having a stroke,
but also advise the caller to seek
immediate treatment by calling 911
or a similar emergency number.
More receptionists in the current
study could name at least one sign
or symptom of stroke in comparison
to the healthline operators affiliated
with academic neurology programs
surveyed in a similar study 2 (95%
versus 76%, respectively). However,
despite the majority of participants
in both studies being able to name
one stroke sign or symptom, both
groups gave incorrect treatment
advice greater than 1 in 5 times (29%
in the present study versus 22% in
the Healthlines study). It is therefore
possible that both the receptionists
and hospital operators may not
have made the crucial link between
recognition of stroke signs and
symptoms AND the need to call 911
for immediate transport to a hospital.
There are no definitive answers
as to why this linkage problem may
exist. However, one reason may be
that many stroke onsets are often not
accompanied by pain. 6 This fact could
partially explain the observation
that 100% of our participants
recommended calling 911 for our
heart attack scenario, which included
mention of pain; whereas, our
stroke scenario was not described as
painful. Severe pain during stroke
onset has also been associated with
decreased presentation delay. 6
The perceived severity of the
stroke symptoms could also affect the
advice given. 7,8 Previous research has
shown that motor weakness 7,8 and
speech disturbances 8 are associated
with shorter delay. However, our
stroke scenario included both of these
symptoms. Perhaps it is difficult to
fully assess the severity of stroke
symptoms over the phone, because
a person cannot directly visualize
the potential stroke patient. This
situation could explain, in part,
the incorrect treatment advice
given in our study. A caller’s
tone of voice may also impact the
perceived urgency of symptoms
on the part of the contacted, but
we did not test this variable.
Limitations
As with any study, there are
limitations to our reported results.
Specifically, these results are
based on responses from only 42
subjects, which contributes to some
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March/April 2011 | Vol. 107 27