EMS Policy Ignores Medical Advances Snake Bites, Chest Pains, Trauma All Rank Ahead Of Strokes On EMS Priority List

The City’s Emergency Medical Service (EMS) is reportedly putting thousands of Queens stroke patients at risk because of a policy oversight that fails to recognize medical advances in treatment of this condition.
As a result of this oversight stroke, or brain attack as it is now called, only ranks 26th on EMS’ list of ambulance case priorities.
Queens neurologists say that faster action is needed by EMS ambulances because new treatments are now available to save lives and reduce serious disabilities.
They point to the growing number of stroke cases and want EMS to upgrade strokes from segment four to segment one, right alongside cardiac arrest and choking.
Their goal: get stroke patients into the emergency room more quickly so they can save more lives and prevent serious disabilities.
According to Dr. Emilio Oribe, director of the division of neurology at New York Hospital Medical Center of Queens, the situation is serious with approximately 3,500 borough residents suffering strokes annually.
"The incidence of stroke is believed to be high because the borough has one of the largest aging populations in the country," he said.
Census statistics show there are 300,000 individuals over 60 in Queens – a group vulnerable to strokes.
Oribe said the lower priority category assigned strokes by EMS is probably due to the fact that in years past neurologists lacked the therapy to effectively treat stroke patients. In triaging, or assessing cases, EMS concluded that other types of medical problems would benefit more from priority attention.
"But now with TPA, the new clot-busting drug, available in every emergency room in Queens," Oribe said, "we can save more lives and reduce the level of disabilities caused by stroke."
Another neurologist, Dr. Vladimir Vlatnik of North Shore Forest Hills Hospital, agreed with Dr. Oribe’s view that stroke priorities should be upgraded by EMS.
"By upgrading stroke to segment one we will save more lives and patients will suffer fewer disabilities," Vlatnik said.
He pointed out that the availability of TPA in borough emergency rooms means that lives can be saved if patients arrive in the ER under the three-hour window of opportunity for treatment with the drug.
"Heart patients have a six-hour window," he said. "So stroke patients should get a high priority by EMS."
The Queens Courier obtained a copy of the EMS’ categories of "call types" the Fire Dept., operator of EMS, uses to prioritize calls received through 911.
It shows that snake or spider bites, burns and injuries are given higher priorities than stroke cases.
Repeated attempts to get an EMS reaction to the neurologists’ complaints were unsuccessful
Frank McCarton, a spokesperson for EMS, would only say that "heart cases have priority over stroke patients."
According to Christine Kureshi, Chair of the 911 Committee, a group that sets EMS policy on ambulances, the stroke situation is not on the Committee’s agenda for discussion.
Congressman Joseph Crowley, a Jackson Heights Democrat whose district has a high percentage of elderly constituents, called upon EMS to assign strokes a higher priority.
"Now that there are new drugs to treat stroke," he said, "it makes sense to give priority attention to this condition," he said.
Crowley said it also makes economic sense to change the system so that strokes are of a higher priority. He noted that effective treatment would enable patients to return to productive lives more quickly.
Meanwhile, State Senator Daniel Hevesi of Forest Hills said he will investigate the reasons for EMS’ system for assigning such a low priority to stroke patients.
"I am extremely concerned about why a condition with such serious symptoms as these aren’t included with heart attacks and choking in EMS’ top priority section."
Stroke, or brain attack, occurs when a blood vessel bringing oxygen and nutrients to the brain bursts or is clogged by a blood clot or some other particle. Without oxygen, the nerve cells in that area die within minutes. The part of the body these brain cells control cannot function, and strokes can, on occasion, lead to death.
Brain attack affects 750,000 Americans, according to the American Assoc. of Neuroscience Nurses. Yet amazingly only 3.5 percent of these patients receive appropriate treatment, according to the Association.
The National Stroke Association offered the following warning signs of stroke:
• Weakness, numbness, or paralysis of face, arm, or leg — especially on one side of the body.
• Sudden blurred or decreased vision in one or both eyes.
• Sudden and severe headache with no apparent cause.
• Sudden confusion, trouble speaking or understanding.
• Loss of balance or coordination, especially when combined with another symptom.