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What Every Officer Needs to Know About Strokes

Early identification of stroke symptoms and FAST action is the key to surviving a stroke and to minimizing long-term disability.  Studies show that 93% of the population knows that sudden numbness on one side as a symptom of stroke. However, only 38% were aware of all five of the major symptoms and knew to call 9-1-1 when someone was having a stroke.  Where do you stand on the stroke learning curve?

Time is of the utmost importance in relation to a stroke…the magical number is to be in the ER in 3 hours or less.  It could save a life, even your own.  And yes, even arrestees and prisoners can have a stroke and it is prudent that you take notice and act FAST for them too.

Patients who arrive at the emergency room within three hours of their first symptoms tend to be healthier three months after a stroke than those whose care was delayed.

Strokes - The Facts:

  1. Stroke is the leading cause of serious, long-term disability in the United States.
  2. Stroke is the fourth leading cause of death in the United States.
  3. More than 140,000 people die each year from stroke in the United States.
  4. Up to 80% of strokes are preventable; yes, you can prevent a stroke!
  5. Each year, approximately 795,000 people suffer a stroke.  A stroke occurs every 40 seconds.
  6. About 610,000 of these are first attacks, and 185,000 are recurrent attacks.
  7. Strokes can and do occur at ANY age.
  8. Approximately 25%of strokes occur in people under the age of 65.
  9. The risk of having a stroke more than doubles each decade after the age of 55.
  10. Stroke costs the United States an estimated $38.6 billion each year( cost of health care services, medications, and missed days of work

What is a Stroke?

A stroke or "brain attack" occurs when a blood clot blocks an artery or a blood vessel bursts spilling blood into the spaces surrounding brain cells.  This results in the interruption of blood flow to an area of the brain.  When either of these things happen, brain cells begin to die and brain damage occurs.  This process is also called a cerebrovascular accident (CVA).

Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain. When brain cells die during a stroke, abilities controlled by that specific area of the brain are lost.  These abilities include speech, movement and memory.  How a stroke patient will be affected depends on where the stroke occurs in the brain and how much the brain is damaged.

Small strokes may result in only minor problems such as weakness of an arm or leg.  Whereas, people who suffer larger strokes may be paralyzed on one side; lose their ability to speak; or even die.    Some people recover completely from strokes, but more than 2/3 of survivors will have some type of persistent disability.

There are actually two types of strokes:

1.         Ischemic: blood clots block the blood vessels to the brain.  87% of all strokes are ischemic. A TIA is a transient ischemic attack, basically it is a "mini stroke" from a temporary blockage by a clot.

2.         Hemorrhagic: bleeding into or around the brain.

The Signs and Symptoms of a Stroke

Remember stroke symptoms can vary from person to person or gender.  Common stroke symptoms seen in both men and women:

  • Sudden numbness or weakness of face, arm or leg -- especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

Women may report other unique stroke symptoms:

  • Sudden face and limb pain
  • Sudden hiccups
  • Sudden nausea
  • Sudden general weakness
  • Sudden chest pain
  • Sudden shortness of breath
  • Sudden palpitation

Strokes Require an Emergency Response:  What you should to if you suspect a stroke.

Assess the situation, the individual’s symptoms; take a quick history if others witnessed the stroke.  Remember this acronymACT F.A.S.T.

F—FACE: Ask the person to smile. Does one side of the face droop?

A—ARMS: Ask the person to raise both arms. Does one arm drift downward?

S—SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange?

T—TIME: If you observe any of these signs, call for a paramedic response immediately.  Do not attempt to drive to the hospital yourself.

Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. It is important to note the time when the symptoms first appeared. There is a FDA-approved clot-buster medication that may reverse or reduce long-term disability if given within 3 hours of when the 1st symptoms occurred. 

Prevention:  Do You Know Your Stroke Risk Factors?

Controllable Risk Factors

  1. Hypertension: High blood pressure is a major stroke risk factor if left untreated.
  2. Atrial fibrillation: Afib is an abnormal heartbeat that can increase stroke risk by 500%. Afib can cause blood to pool in the heart and may form a clot and cause a stroke. A doctor must diagnose and treat Afib.
  3. Smoking:  Smoking doubles the risk of stroke. It damages blood vessel walls, speeds up artery clogging, raises blood pressure and makes the heart work harder.
  4. Alcohol use:  Alcohol use has been linked to strokes in many studies. If you drink, drink in moderation: no more than two drinks each day.
  5. Elevated cholesterol levels:  High cholesterol levels can clog arteries and cause a stroke. See a doctor if your total cholesterol level is more than 200.
  6. Being overweight/obese: Excess weight strains the circulatory system.
  7. Diabetes
  8. Other  circulation problems 

Uncontrollable Risk Factors

  1. Age:  A stroke can happen to anyone, but risk of stroke increases with age. After the age of 55, stroke risk doubles for every decade a person is alive.
  2. Gender:  Women suffer more strokes each year than men... Additionally, women are two times more likely to die of a stroke than breast cancer annually.
  3. Race:  African Americans have twice the risk of stroke when compared to Caucasians. Hispanic and Asian/Pacific Islanders also have higher risk than Caucasians.
  4. Family history:  If a family member has had a stroke, everyone in the family has a higher risk of stroke.
  5. Previous stroke or TIA: Up to14% of the people who have a stroke this year will have a second one. Within the next 5 years, stroke will recur in 24 percent of women and 42 percent of men.
  6. Younger people are more likely to get strokes due to atypical risk factors:  underlying medical disorders, genetic disorders, blood clotting abnormalities, and patent foramen ovale (a hole in the wall between the right and left atria of the heart). 

You should review all of your risk factors with your physician

Tips Specifically for Law Enforcement

You, your agency, or your detentions facility are liable for failure to identify stroke symptoms.  There are several cases when the detained individual was not assessed appropriately to determine a possible stroke.  Many stroke symptoms can mimic alcohol impairment or resistance: slurred speech, blurred vision, inability to exit a car, confusion, dizziness/trouble walking/lack of balance. 

The following is a true case:  On May 11, 2012 Daniel Hicks, 51, was found stopped in his car on the side of a highway in Tampa.  Witnesses had called 911 after they saw Hicks' car swerving west into a guardrail.  When highway troopers arrived Hicks could not speak coherently; he was unable to move his left arm.  It was noted that he did smell of an alcoholic beverage and that he was not acting erratically.  Deputies from the sheriff’s department also responded to the scene.  Nonetheless, officers arrested Hicks on a charge of obstructing a law enforcement officer when he failed to respond to commands to exit his car. He was taken to Orient Road Jail; he received no medical screening at intake.  Hicks was placed in a cell, where he laid facedown and tried to crawl using the one working side of his body; he soaked himself with urine.  It wasn’t until the following day that he received a medical evaluation at the jail.  He was then taken to Tampa General Hospital and diagnosed with an ischemic stroke. 36 hours had lapsed since his first symptoms.  He slipped into a coma and died within three months. On July 30, 2013 the Hillsborough County Sheriff's Office and the private company that provides medical care to county prisoners was ordered to pay $1 million in a wrongful-death settlement to the children of Daniel Hicks.  Additionally the Hillsborough County S.O. has instituted new training on recognizing stroke symptoms for deputies.

There is a new movement pushing for people to think of a stroke as a "brain-attack" like a heart attack.  Essentially they are the same thing, but the blockages are in different organs.  Well, they can transplant hearts now, brains not so much.  So take care of yourself—remember a brain is a terrible thing to waste.