When the diagnosis of stroke is unnecessarily delayed, the patient’s treatment options become critically limited. Thromboembolic strokes, i.e., those caused by blood clots (thrombus) that travel (embolize) through blood vessels to cut off blood flow to the brain, can be treated by clot busting medications (thrombolytics such as tPA), but only if treatment is commenced within a certain time frame. To increase the likelihood that patients will arrive at the hospital in time, the American Heart Association is promoting the F.A.S.T. protocol.
F.A.S.T. stands for face, arm, speech and time. The first three items, face, arm and speech, refer to the fact that most strokes manifest with these symptoms: facial drooping, arm weakness and slurred speech. “Time” refers to the need to document when these symptoms first arise, call 9-1-1, and get to a treatment center as quickly as possible so that treatment can be initiated within the window of opportunity.
Hospitals have their own protocols for making sure that clot busting treatment is started in a timely manner. Major hospitals have stroke teams and MRI facilities needed to assess patients, get the necessary imaging to confirm the diagnosis, and initiated treatment, all on a timely basis. When the patient does their part, and promptly arrives at a hospital soon after symptoms arise, the hospital team must do its part, too. Any preventable delay in treatment may furnish the basis for a medical malpractice claim.
The costs associated with care of patients who suffer permanent brain injury are staggering. Patients frequently need expensive acute care, such as an extended ICU stay, then rehabilitation, PT, OT, speech therapy and help with activities of daily living, which includes direct care in a modified home or a skilled nursing facility and specialized transportation.