Medical advances help Stroke Program rate high for survival and recovery thanks to medical advances — and a coordinated, community-wide effort to put them to use — Mills-Peninsula is sending more people home without the severe disabilities that can result from a massive stroke.

"We were certified as a Primary Stroke Center by the Joint Commission on Accreditation for Healthcare Organizations in September, 2006," Kathleen MacKerrow, R.N., Mills-Peninsula’s Stroke Program coordinator, said.

"Since then we’ve administered the clot-busting drug t-PA to more than 20 people between the ages of 20 and 100 with good results regardless of age."

When given within three hours of the onset of symptoms, t-PA can help avoid or minimize brain damage resulting from ischemic or blockage type of strokes. These account for about 80 percent of strokes.

"For example," MacKerrow said, "thanks to t-PA, several patients over the age of 90 were treated recently and were able to return home. Their functional status improved to the point that they were able to function as before"

Stroke is the third leading cause of death and the number one cause of serious, long-term disability in the United States. Helping people beat those odds with a quick, coordinated response is what won Mills-Peninsula’s program it’s 5-star HealthGrades rating, the stroke care coordinator and geriatric clinical nurse specialist said.

"We were the only program in the county to win the rating in three different measures: In-hospital survival, survival and recovery after 30 days and after six months from discharge."

A call from paramedics in the field triggers a stroke alert at Peninsula Medical Center where key personnel prepare emergency services, ready scanners, alert lab and pharmacy.

"Our goal is to get a CT scan completed within 25 minutes of arrival," MacKerrow said.

The CT scan indicates which type of stroke has occured, which is one way to determine if t-PA can be considered as treatment..

"While t-PA can not be used to treat the approximately 20 percent of strokes caused by a burst artery in the brain (hemorrhagic strokes), other neurosurgical procedures might be considered," MacKerrow said.

"A stroke care coordinator will follow the patient throughout their hospital stay to help prevent complications and collaborate with the health care team to determine the next level of care, such as acute rehabilitation at Mills Health Center," she said.

"The earlier rehabilitation starts, the better the outcome for patients."

The coordinator also teaches patients and caregivers about the cause of their stroke and how to treat risk factors.

"The highest risk for a second stroke is immediately following the first incidence," MacKerrow said.

She stressed that the recent 15 percent increase in stroke patients brought by ambulance to Mills-Peninsula indicates the success of a county-wide effort to educate the community and coordinate the health care response.

More than 300 paramedics and fire department workers have been trained in detail on how to assess stroke and rapidly transport patients to the appropriate facility, according to Barbara Pletz, San Mateo County Emergency Services administrator.

"If the onset of symptoms is within 2.5 hours the 911 ambulance will take patients to a Primary Stroke Center. If more than 2.5 hours but less than 8 hours have passed, they are taken to a Comprehensive Stroke Center with capability to perform invasive procedures in the hopes of restoring blood flow to the brain and reducing disability."

This two-tiered response system puts stroke care in San Mateo County far above most other counties in California, Pletz said.

And rounding out the concerted effort to improve stroke outcomes in San Mateo County, the Hospital Consortium is leading a stroke awareness campaign to educate the community.

"We are trying to up the number of patients brought into emergency services via ambulance within those eight hours by increasing awareness of the signs of stroke and importance of calling 911," Francine Serafin-Dickson, Hospital Consortium executive director said.

Among other educational efforts, the group will roll out an ad campaign in the spring and collect county data on stroke incidents and treatment to measure success.

"We want the public to know that stroke is treatable," Serafin-Dickson said.