[Congressional Record (Bound Edition), Volume 154 (2008), Part 5]
[Senate]
[Pages 5972-5973]
[From the U.S. Government Publishing Office, www.gpo.gov]




              TREATING VICTIMS OF STROKE MORE EFFECTIVELY

  Mr. KENNEDY. Mr. President, a recent article in the Washington Post 
highlights the serious additional harm that is being done to victims of 
stroke each and every day by our failure to get them as quickly as 
possible to hospitals or other treatment centers qualified to provide 
the timely, appropriate care that can make all the difference between 
recovery and permanent disability or death.
  Not all hospitals have this capability, and Massachusetts and a 
handful of other States have begun implementing systems to make better 
quality care available and to inform the public and emergency medical 
services of the location of the nearest facility capable of providing 
such care. What is needed most, however, is national leadership to make 
prompt and quality care for stroke victims a reality throughout this 
country.
  I believe our colleagues in the Senate and House will be interested 
in this important article, and I ask unanimous consent to have it 
printed in the Record.
  There being no objection, the material was ordered to printed in the 
Record, as follows:

                [From the Washington Post, Apr. 1, 2008]

                          New Rules on Stroke


                  Care Center Networks May Save Lives

                            (By Alicia Ault)

       In the event of a stroke, time is brain--meaning the more 
     quickly you recognize the problem and get proper medical 
     treatment, the more likely you are to survive and minimize 
     neurological damage. Increasingly, experts are concluding 
     that means getting to the right hospital, and fast.
       According to the American Stroke Association and many 
     neurologists, the right facility is one that has been 
     designated by a state agency or the Joint Commission (which 
     accredits hospitals for quality and safety) as having the 
     appropriate medical staff, the ability to quickly administer 
     such diagnostic tests as computed tomography, and a 
     potentially lifesaving drug, tissue plasminogen activator 
     (TPA), which dissolves clots.
       In some states, including Maryland, you don't have to worry 
     about which hospital might be best. Ambulance crews who 
     suspect a stroke are required to seek out a designated stroke 
     center, unless the nearest one is an unreasonable distance 
     away.
       Now health officials in Virginia and the District say they 
     are considering similar plans.

[[Page 5973]]

       In March, Virginia Gov. Timothy M. Kaine signed a bill 
     requiring local health officials to rush stroke patients to 
     Joint Commission-certified primary stroke centers. Even 
     though that law has not yet taken effect, emergency medical 
     technicians typically route patients to stroke centers, said 
     Paul Sharpe, trauma and critical care coordinator for 
     Virginia's Office of Emergency Medical Services.
       In Washington, Michael Williams, medical director of Fire 
     and Emergency Medical Services, said he soon will issue a 
     protocol requiring transport of suspected stroke patients to 
     Joint Commission-certified stroke centers. That rule should 
     take effect within a month or so.
       Until those changes take place, Virginia and District 
     residents might be wise to know the signs of stroke. If they 
     suspect they're having a stroke, they then, directly or 
     through a family member acting on their behalf, might ask to 
     be taken to a specialized stroke center.
       About 780,000 Americans have a stroke each year. The vast 
     majority of strokes, 87 percent, are ischemic, caused by a 
     clot that cuts off blood supply to the brain, according to 
     the American Heart Association.
       TPA, when given within three hours of the onset of a 
     stroke, can increase the chances of a full neurologic 
     recovery by at least 25 percent, said Robert Bass, executive 
     director of the Maryland Institute for Emergency Medical 
     Services Systems, or MIEMSS. But the drug's associated risks, 
     which include major bleeding in the brain, make it even more 
     crucial to get care at the right facility, Bass said.
       Finding a hospital that specializes in stroke care is even 
     more important at a time when most are having trouble finding 
     specialists to ``take call''--that is, to see patients at the 
     hospital.
       There are no hard numbers on the shortage, but the American 
     College of Emergency Physicians reported in 2006 that three-
     quarters of emergency departments nationwide had problems 
     finding specialists such as neurosurgeons to take call. The 
     shortage was especially acute in orthopedics, plastic surgery 
     and neurosurgery.
       Being seen by a neurology specialist doesn't guarantee a 
     good stroke outcome. But it is crucial to have a physician 
     trained in stroke care, said Lee Schwamm, vice chairman of 
     the neurology department and director of acute stroke 
     services at Massachusetts General Hospital in Boston.
       ``Many people assume that stroke can be and is treated by 
     anyone,'' he said, which simply isn't true.
       Massachusetts was the first state to create a stroke care 
     system, in 2004, partly because of the problem of getting on-
     call specialists. Under the plan, designated hospitals agree 
     to have the appropriate diagnostics and staff (including 
     neurologists on duty or available through telemedicine) and 
     the ability to give TPA within three hours. They also agree 
     to report on the quality of care.
       In mid-2005, the state began requiring ambulances to take 
     patients to stroke centers. Within a year, the number of 
     stroke patients receiving TPA increased by 20 percent, 
     Schwamm said. Now the goal is to increase the number of 
     patients who get to the hospital in time, he added. Sixty-
     eight of the state's 72 hospitals have been designated as 
     stroke centers by the Massachusetts health department.
       Several states have followed Massachusetts's lead, 
     including Maryland (in 2007), New York, New Jersey and 
     Florida.
       Maryland hospitals that apply for the stroke center 
     designation are evaluated by a state inspection team. 
     Hospitals can also be certified by the Joint Commission.
       The nonprofit commission began certifying stroke centers in 
     2003. So far, 455 hospitals nationwide have received that 
     designation.
       Twenty-eight hospitals have received Maryland's five-year 
     stroke center certification. These hospitals can evaluate 
     stroke patients, give the initial treatment and, in most 
     cases, admit patients directly to a special stroke unit in 
     the hospital, Bass said. Since the program's establishment, 
     the number of patients receiving clot-busting therapy has 
     increased 20-fold, said John Young, stroke system coordinator 
     for MIEMSS.
       Like the District, Virginia does not have its own stroke 
     center certification process.
       Certification isn't a guarantee of superior care, said 
     Ralph Sacco, chairman of the American Stroke Association's 
     Stroke Advisory Committee and chairman of neurology at the 
     Miller School of Medicine at the University of Miami. But 
     it's an indicator that the hospital has the infrastructure in 
     place--and the commitment--to deliver high-quality treatment, 
     he and Schwamm agreed.
       What should you do if you think you or a loved one are 
     having a stroke?
       The keys to a good outcome, Schwamm said, are knowing the 
     warning signs, calling 911 immediately and getting to a 
     primary stroke center.
       He and others say they hope that every state adopts a 
     system to require transport to those centers. It could be a 
     lifesaving trip.

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