Health
Four out of five people in the United States live within an hour's drive of a hospital equipped to treat acute stroke – yet very few get recommended treatment, according to research presented at the American Stroke Association's International Stroke Conference 2014.
Of the more than 370,000 Medicare stroke claims for 2011 that researchers examined:
- Only 4 percent received tPA, a drug that can reduce disability if given intravenously within three to four hours after the first stroke symptoms.
- Only 0.5 percent had endovascular therapy to reopen clogged arteries.
These treatments are most likely available at designated stroke centers, where a team of providers are trained to quickly diagnose and treat strokes.
“If a patient suspects they are having a stroke, they need to call 9-1-1 immediately and get to the nearest stroke center as soon as possible, which might mean bypassing another hospital that isn't set up to deliver the necessary therapy,” said Opeolu Adeoye, M.D., M.S., the study's lead author and associate professor of emergency medicine and neurosurgery at the University of Cincinnati.
“We strongly suggest that patients go to the hospital by ambulance, that they or whoever is with them ask to go to a stroke center and ask for tPA.” The study found that within an hour's driving time:
- Eighty-one percent had access to a hospital capable of administering tPA.
- Sixty-six percent had access to a primary stroke center.
- Fifty-six percent had access to a hospital capable of performing endovascular therapy.
Within an hour by air:
- Ninety-seven percent could reach a tPA-capable hospital.
- Ninety-one percent could reach a stroke center.
- Eighty-five percent could reach a hospital capable of performing endovascular therapy.
In 2011, 60 percent of U.S. hospitals didn't administer tPA. These hospitals discharged about 1 in 5 of all stroke patients.
“Every 15-minute delay in getting treatment increases the odds of that patient not being able to go home,” Adeoye said. “Calling 9-1-1 is best if a stroke is suspected because paramedics should know which hospitals are stroke centers and can alert the stroke team in advance of the patient's arrival, all of which saves time.”
For additional information on stroke warning signs, visit http://powertoendstroke.org/stroke-recognize.html .
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FALLS CHURCH, Va. – Older firefighters who are chronically exposed to heat stress on the job could be more heat resilient over time.
A recent study published in the December issue of the Journal of Occupational and Environmental Hygiene (JOEH) found that older firefighters may be able to tolerate more challenging or arduous work environments before they feel affected by the heat, compared to non-heat-exposed workers who would need to stop work prematurely.
“We found that the firefighters experienced reduced subjective feelings of thermal and cardiovascular strain during exercise compared to the non-firefighters, potentially indicative of greater heat resilience in firefighters due to the nature of their occupation,” said study investigator Glen P. Kenny, PhD, a professor at the School of Human Kinetics at the University of Ottawa in Ontario, Canada.
The researchers examined a group of older, physically active non-firefighters and firefighters, approximately 51 years old, during intermittent exercise in two heat stress conditions, to investigate the potential thermal, cardiovascular and hydration effects of repeated occupational heat stress.
While Kenny and his colleagues found no differences in the level of thermal and cardiovascular strain between the older heat-exposed firefighters and non-heat-exposed older workers, the non-heat-exposed workers felt more heat stressed relative to the older firefighters and felt that the work performed was physically more challenging.
“If you have older workers who work in the heat, they are in a better position to handle working in the heat as compared to their non-heat-exposed counterparts,” said Kenny. “If they can better handle the heat stress, they can better perform challenging tasks without putting themselves at greater risks of injuries caused by impairments in mental function, alertness, concentration, motor dexterity and coordination.”
Prior to this study, physiological strain had been examined in young and middle-aged firefighters during live firefighting and simulated drills, but the responses of older and more experienced firefighters had not previously been investigated.
“Our discovery is especially important given recent findings that aging can decrease an individual's ability to dissipate heat and therefore work in hot environments,” added Kenny.
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