TIMING IS OF THE ESSENCE UCLA TRIES TO HURRY AID FOR STROKES.

Byline: Evan Henerson Staff Writer

The moment a stroke occurs, a high-stakes game of ``beat the clock'' begins - between you and your brain cells.

The faster you dial 911 and get to an emergency room for treatment, the better your chance of survival and successful rehabilitation. The longer the delay, the greater the damage. Thus, any doctor will tell you that if you suspect you're having a stroke, get to the hospital - and fast. The window of opportunity is typically short: a mere three to six hours from the first symptoms to the point damage to the brain is irreversible and, in some cases, fatal.

That rapidly closing window is the reason stroke specialists at UCLA say the person (or medical team) who gets you to the appropriate hospital could play nearly as vital a role in your recovery as the doctor who treats you.

And they have put this theory to the test.

A pilot program between the UCLA Stroke Center, the USC Department of Emergency Services and the Los Angeles Fire Department has identified paramedics and emergency medical technicians as key players in the improvement of stroke treatment.

Over a three-year period, more than 3,000 paramedics with the L.A. Fire Department have been trained in the Los Angeles Prehospital Stroke Screen (LAPSS) guidelines designed to help paramedics recognize early stroke symptoms. Paramedics using the guidelines proved 91 percent effective in correctly identifying stroke victims, according to recently published data.

``We're very lucky to have this system in place,'' said Dr. Sidney Starkman of the UCLA Stroke Center. ``Ours were the first in the country who have been proven to accurately identify stroke victims in the field. Our paramedics are fabulous.''

LAPSS is a one-page set of guidelines that lists several categories for determining whether a patient is having a stroke. The paramedic looks for several signs, including drooping face or grimace, weakened grip or diminished arm strength and abnormally high or low blood sugar levels.

If any of the criteria are met, the paramedic telephones ahead to the nearest receiving hospital and signals a ``stroke code.'' With this early alert, the hospital staff is prepared to treat the patient upon arrival, with no unnecessary delays. A CT scan - read by a qualified physician - will confirm a stroke diagnosis.

Doctors are hoping the LAPSS guidelines and, in the future, the creation of specially designated stroke centers will help Los Angeles become a model for stroke treatment across the nation. Given the importance of response time, a city as large and spread out as L.A. demands nothing less, stroke specialists claim.

Dr. Marc Eckstein, medical director for the L.A. Fire Department and base station medical director for County USC Medical Center, said participating paramedics were equally enthusiastic about the program, even if it meant additional training and paperwork during the research phase. Today, even without the guidelines in hand, the LAPSS-trained paramedics can pinpoint stroke symptoms and know to move fast, Eckstein said.

``In my experience, if it makes sense for patient care, it makes sense to the paramedics,'' said Eckstein, adding that this is a rare joint venture with researchers from UCLA and USC working together. ``We're working in a research capacity, doing cutting-edge work. We're appealing to their sense of professionalism.''

Often referred to as a ``brain attack,'' the stroke is the nation's No. 3 killer, after heart attacks and cancer. The most common form of stroke occurs when a blood clot gets stuck in one of the brain's arteries, choking off the blood supply. Unless it can be dislodged within six hours or so, a section of brain dies, causing paralysis and other problems.

If administered quickly, medication has been demonstrated to quickly reverse symptoms such as paralysis and slurred speech. Recent studies have shown that a clot-dissolving medication, tissue plasminogen activator (t-PA), is highly effective in reversing the effects of the most common forms of strokes when administered within three hours of early symptoms. This medication does, however, pose the risk of causing bleeding into the brain.

This type of aggressive treatment is, at this point, well beyond the jurisdiction of paramedics, even those well-versed in the LAPSS guidelines. Paramedics are permitted to perform more basic emergency procedures such as administering oxygen, insulin or setting up an intravenous line.

``You could fill up the paramedic's bag with a lot of other medicine that could be beneficial, but a lot of it would be dangerous drugs,'' said Capt. William Wells, a paramedic in the L.A. Fire Department's planning division. ``For treating a stroke, you don't want to spend all that time putting a needle in a vein when you could be picking the right hospital and getting the patient to the hospital faster.''

But as the trials expand, paramedics might be asked to play a larger role in stroke treatment. In the next phase of the study, L.A. paramedics will start administering magnesium - a neuroprotective agent - to stroke victims via an intravenous line.

When they learned of the success of the early LAPSS trials, hospitals began contacting the UCLA doctors to see how they might put such a program to use. According to Starkman, the LAPSS guidelines could easily become a model for paramedic/hospital stroke treatment partnerships in other major cities.

Dr. Jim Shields, an anesthesiologist at Houston Medical Center in Perry, Ga., agrees.

``The problem with strokes has become extremely acute across the country,'' said Shields. ``Our emergency medical training is as advanced as it would be in a major urban area, but in our rural areas, paramedics have to cover a greater geographic distance.''

It helps to know what a stroke is

--What is it?: Also called a brain attack, a stroke describes the symptoms of a patient with an injury to the brain from a lack of blood flow or from bleeding. When blood flow fails, brain cells are robbed of vital supplies of oxygen and nutrients. Some strokes have little recognizable effects. Others can quickly cause death.

--Types: Ischemic strokes are those caused by blood clots that block blood flow. Those caused by bleeding are called hemorrhagic strokes. About 400,000 strokes in the United States are caused by blood clots; 100,000 by bleeding into the brain or spaces around the brain.

--Effects of stroke in U.S.: Stroke ranks as the third leading killer in the United States, after heart disease and cancer. About 150,000 Americans die each year from strokes. As many as 3 million Americans have survived a stroke, more than 2 million of them sustaining a permanent disability. The overall cost of stroke to the nation exceeds $30 billion a year.

--Stroke signs: Clues the body sends that the brain is not receiving sufficient oxygen are sudden weakness of the face, arm, leg or on one side of the body; sudden difficulty speaking or trouble understanding speech and sudden loss of vision on one side or in one eye.

--Risk factors: High blood pressure, cigarette smoking, heart disease and diabetes. In African-Americans, the death rate from stroke is almost twice that of the white population.

- The National Institute of Neurological Disorders and Stroke 

The facts

--What: Stroke Association of Southern California's 11th annual Run/Walk.

--Where: UCLA's Jackie Robinson Baseball Stadium on the West Los Angeles V.A. Hospital grounds.

--When: 7 a.m. to noon June 11. The morning will include a 5K run/walk, 2K fun run/walk, exhibitors and entertainment. The event raises money for stroke awareness and prevention.

--Information: If you're interested in participating or volunteering, call [phone].

CAPTION(S):

2 photos, box

Photo:

(1 -- cover -- color) L.A. Fire Department paramedic Jan Lowe demonstrates a test performed on potential stroke victims.

(2) L.A. Fire Department paramedic Dave Monette shows the stroke screen test given to victims this year.

Photo illustration by David Crane/Staff Photographer

Box: It helps to know what a stroke is (See text)