Queens Pols Win 911 Ambulance Stroke Reform EMS Agrees To Consider Installing Phones

The medical arm of the New York City region’s EMS (Emergency Medical Services) last week ordered a "re-investigation" of the City’s alleged slow ambulance response time on stroke patients after an appeal from State Assemblywoman Nettie Mayersohn of Flushing.
The decision by the Regional Emergency Medical Advisory Committee constitutes a victory for Queens neurololgists and legislators who mobilized after a Queens Courier series revealed that EMS policies list stroke, the third leading cause of death in the U.S., as 26th on its list of emergency priorities and fourth in its eight triage categories.
Mayersohn appeared at the medical advisory group’s meeting in Manhattan on Sept. 21 urging it to assign a higher priority to stroke patients so that they might benefit from the recently-developed "clot buster" drugs such as TPA.
After a defense of its policies, the Chair of the medical group, Dr. Arthur Cooper of Columbia University College of Physicians and Surgeons, authorized a reinvestigation of stroke priorities for the City’s ambulances
"We first looked into this matter in 1996," he said, "but perhaps it is time to look into it again because medical technology changes as does the medical literature on the subject."
Mayersohn, an advocate of underserved groups in Queens and throughout the City, also extracted another promise from the medical group. It promised to consider installing cell phone communication in City ambulances to enable technicians and paramedics to notify hospital emergency rooms to prepare for the arrival of a critically ill stroke patients."
"This can save lives," Mayersohn said in an interview. "My husband had a heart attack in Albany and the ambulance technician was able to communicate with the emergency room at the Albany Medical Center. But in New York City we don’t have this capability."
The feisty Flushing Assemblywoman had learned earlier from First Deputy Fire Commissioner William M. Feehan of the New York City Fire Department, which operates EMS, that lack of funds prevented the installation of the cell phones. He noted that EMS ambulances only had radios to put them in touch with their dispatchers, but not hospitals. However, in nearby Nassau and Suffolk Counties emergency officials said their ambulances were equipped with radios that enable technicians to speak directly with hospital emergency rooms.
Cooper agreed to a Mayersohn request that members of the advisory committee join a Queens medical task force on stroke proposed earlier by Shulman.
Mayersohn also asked the advisory committee for guidelines to assure Queens patients that the hospital chosen for stroke patients by EMS have effective stroke teams.
She was told that such a listing would be developed by the committee for the information of patients. However, Cooper indicated that "hospital politics" dictated the marketing programs that position hospitals as bona fide stroke centers."
"Our Committee has no authorization here," he said. "That is the responsibility of the New York State Department of Health under Article 28."
He added that "hospitals will advertise that they are specialists in the care of stroke patients because of competitive pressures."
A source close to the regional medical council said that at present no government agency has the authority to investigate hospital claims that they provide stroke teams to care for these patients.
Mayersohn made it clear that "we want to know which hospitals in Queens are staffed with stroke teams and possess the necessary equipment to evaluate and treat stroke patients on a 24-hour basis."
She also asked if it’s preferable for stroke patients to be taken to the nearest hospital or to a recognized tertiary care (advanced) institution such as New York Presbyterian Hospital or Mount Sinai Medical Center?
Cooper said he was unable to answer that question.
One major obstacle to successful stroke treatment is the lack of public awareness of the symptoms.
Only 58 percent of patients in a recent Gallup Poll of persons over age 50 recognized weakness of an arm or leg as symptoms of stroke and only 32 percent recognized speaking difficulties as a warning sign of stroke. That concern was echoed by the medical advisory group which called for greater public awareness of stroke or "brain attacks" as they are now called.
The Queens legislators position to make stroke a number one EMS priority was substantiated in a recent article in the Journal of the American Family Physician,
"The EMS in many communities do not consider stroke a level-one emergency equivalent to trauma and heart attacks," the article said.
The article urged each hospital to develop a treatment plan for acute stroke that reflects its abilities and limitations. It said "hospitals without brain imaging capacity should never treat patients with TPA. Hospitals with easy-access brain imaging, radiologic expertise and an experienced physician should be able to treat appropriate patients with TPA. However, if an active intensive care unit or neurosurgical expertise is lacking, patients who are treated with TPA should be transferred urgently after treatment has begun to another hospital where these capabilities are present."
The article urged the nation’s family physicians to support efforts to label stroke "the highest level emergency for their community EMS."
Local medical officials were unable to determine if such policies were in force in Queens hospitals. Another article in "Acute Treatment Research," cited common misperceptions of stroke.
"Since the beginning of recorded history stroke has been viewed as unpreventable and untreatable. There was a fatalism involved. People wrongly believe that stroke happens only to the elderly and is therefore not of concern."
The stroke issue will be revisited at Borough Hall soon. Shulman and Mayersohn are expected to convene a Queens task force to push for EMS reforms including improved ambulance communications and elevating strokes to the top of EMS’ priority list.
One of the world’s leading authorities on stroke and emergency medicine, Dr. Sidney Starkman, co-director of the UCLA Stroke Center, had this to say about funding problems in New York City that prevent the installations of cell phones.
"It appears that New York City is in the ‘dark ages’ on this issue," he said. "Notification f rom ambulance to hospital can be very helpful."
Starkman, a former New Yorker affiliated with Columbia University, said his Los Angeles Pre-Hospital Screening Program, was instituted to train and certify paramedics to identify stroke patients who require immediate delivery to the hospital. He said that 500 Los Angeles paramedics have been trained under the program.
No such training program for paramedics exists in New York City.
"We instruct paramedics to identify stroke cases that can be helped, obtain information on exactly when symptoms occurred and talk to the individual who witnessed the episode," the L.A. specialist said.
Starkman, a medical consultant to the National Stroke Association in Englewood, Colorado, also commented on the effectiveness of the TPA drugs. At last week’s regional EMS medical conference some emergency room physicians said the drugs often caused serious side effects including bleeding from the brain.
"If TPA is used properly as indicated in the landmark medical study done on the drug," Starkman said, "patients can benefit and make a complete or near complete recovery."