By Patrick Thatcher
Daily Press
Copyright 2008 Daily Press
VICTORVILLE, Calif. — When a 75-year-old Spring Valley Lake man suffered a stroke recently, he said that paramedics treating him contacted the three major hospital emergency rooms in the area to no avail.
None would administer a highly potent clot-busting drug called TPA (tissue plasminogen activator) to help reverse the stroke’s effects.
Officials at the three major hospitals confirmed they won’t give the drug because of its potential to cause brain hemorrhage and they lack the safeguards of a neurosurgery team.
“Every time you use what are commonly referred to as clotbusting drugs in the case of a stroke, you do run the risk of massive hemorrhage into the brain. Because of that risk you have to have neurosurgical backup at the time,” said Dr. James Kyle, vice president of Medical Affairs at St. Mary Medical Center.
Kyle said they have one neurosurgeon at St. Mary Medical Center, but said more than one is needed to have 24-hour, sevenday-a-week backup.
According to the American Stroke Association, TPA can reduce the effects of stroke and help prevent permanent disability by dissolving blood clots, but ASA recommends not using the drug unless the hospital has a neurosurgical team.
Desert Valley Medical Center admitted the stroke patient to their emergency room and made arrangements for his transfer to San Antonio Hospital in Upland, where neurosurgeons are available and the TPA was administered.
The stroke victim, who wished to remain unidentified, said it took six hours after the onset of symptoms before he was seen by the emergency room doctor at San Antonio Hospital.
The optimal time frame to give TPA is within the first 90 minutes to three hours after suffering a stroke, according to the FDA who approved the drug for stroke in 1996.
Carolyn Hunt, chief nursing officer at Victor Valley Community Hospital, said they are continually developing new programs to meet the growing population of the area.
“As with a procedure of this nature it is imperative that program planning include the development of policies, procedures and protocols including post-TPA administration care,” Hunt said.
A survey of more than 1,100 emergency room physicians by the University of Michigan Stroke Program revealed that 40 percent of emergency physicians are unlikely to give stroke patients TPA for fear of brain bleeding.
St. Mary Medical Center is looking at the prospects of recruiting additional neurosurgical support, Kyle said.
“We are looking at establishing a stroke program which may have to involve not only what we do here, but working with physicians at hospitals in the region that can help support us,” he said.