Stroke alert: Know the signs of a stroke

Ontario is a blueprint for Canada
After five years of innovation, evaluation and adaptation, Ontario has designated 11 hospitals as Regional Stroke Centres, 18 hospitals as District Stroke Centres and 24 clinics as Stroke Secondary Prevention Clinics. There is nothing quite like it in the world, says Silver. With regional adjustments, the Ontario model is providing the blueprint for a Canada-wide stroke-care strategy led by the Canadian Stroke Network.

“We are living in exciting times,” says Dr. Michael Hill, the director of the Calgary stroke unit. “Over the next five years we are going to see big advances in the way Canadians are treated and the type of quality care they receive.”

Hill outlines the big picture province by province

British Columbia: the provincial government has invested $500,000 to begin moving its “stroke charter” from planning to action.

Alberta: the province has committed $20 million over two years to the Alberta Stroke Council.

Saskatchewan: three health regions have committed to enhance stroke services, and a provincial committee has developed a plan for moving ahead.

Manitoba: Brandon and Winnipeg are leading the way in provincial initiatives. Telemedicine is being used to bring the message to remote communities and First Nations peoples.

Quebec: an integrated stroke strategy will be unveiled later this year.

New Brunswick: a provincial stroke network has been established along with development of an awareness package for family physicians.

Nova Scotia: the government is investing $7 million over four years for an integrated stroke strategy and $3 million per year thereafter.

Prince Edward Island: an integrated stroke strategy was formally launched in August 2006.

Newfoundland and Labrador: a provincial stroke strategy is in the planning stages.

While the provinces establish their stroke programs, two vital pieces of information will protect Canadians right now.
• Know the signs and symptoms of stroke and make sure your whole family knows them.
• Know your blood pressure. Uncontrolled high blood pressure is the leading cause of stroke.

Paramedics race against time
At the grassroots level, the new stroke care has placed paramedics on the front line. “And that's where we want to be,” says Jodi Dockman, a supervisor of the paramedical services in Peterborough County, Ont., an area of 4,000 square kilometres with a stroke centre at Peterborough Regional Health Centre. For some stroke patients, that can mean as much as two hours of travel from the onset of symptoms to arrival at the emergency department.

“Then there's an hour at the hospital to process the patient and provide the brain scan, so we are racing against the clock,” says Dockman. “All paramedics are now familiar with the signs and symptoms of stroke and can differentiate between stroke and stroke mimics such as hypoglycemia, substance abuse or psychiatric conditions.” Whenever possible, adds Dockman, a family member travels with the patient to provide informed consent should a patient lose consciousness.

A physician can provide consent to administer tPA treatment if a family member is not available, but it is
more complicated legally.

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