The Golden Hour, Pt. 1 – Stroke Care

Kern Valley
Healthcare District

When it comes to emergency treatment, there is no more important phrase than “The Golden Hour.” This precious 60 minutes of time was first recognized and described by R. Adams Cowley, MD, at the University of Maryland Medical Center in Baltimore. From his personal experiences and observations in post-World War II Europe, and then in Batimore in the 1960s, Dr. Cowley recognized that the sooner trauma patients reached life-saving care – particularly if they arrived within 60 minutes of being injured – the better their chance of survival.

As we fast-forward to the care and treatment of other emergent disease processes, we can link the same phrase to stroke, heart attack and trauma care.

In this first article, I would like to focus on “stroke.” There is an important acronym to remember when thinking about the symptoms of a stroke. That acronym is FAST:

F – Facial Drooping: Does one side of the face droop, or is it numb? Ask the person to smile.
A – Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downwards?
S – Speech Difficulty: Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like, “The sky is blue.” Is the sentence repeated correctly?
T – Time to Call 9-1-1: If the person shows any of these symptoms, even if they go away, call 9-1-1 and get them to the hospital immediately.

This is an easy way to quickly assess whether a higher level of care is needed. Recognizing early symptoms is critical when dealing with a stroke, as the reversal medication must be given within 3 hours of the initial onset.

Tissue Plasminogen Inhibitor (t-PA) is the only medication approved for use in ischemic stroke, and again, it must be administered within 3 hours of the onset of symptoms. Among more than 100,000 patients treated at hospitals participating in the American Heart Association – Get with the Guidelines – Stroke Quality Improvement Program, 27.1 percent who arrived within the “Golden Hour” (one hour of symptom onset) met criteria to receive the clot-busting (t-PA). Of those who arrived between one and 3 hours of symptom onset, 12.9 received the drug. The criteria to receive the medication is stringent, and not all patients meet that criteria. The most important of these criteria is time.

Our local hospital has the specially trained physicians and nurses to care for the patient who presents with these symptoms. With the help of Dignity Healthcare, our local hospital also has access to a neurosurgeon who is on call 24 hours per day and 7 days per week via telemedicine.

The time it takes to drive down the canyon to a tertiary level of care may be the difference between complete recovery from a stroke and a significant, debilitating and irreversible deficit.

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