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Alameda Hospital “After 4-hours” Window for Stroke Victims Makes No Sense

Dear Editor,

Although I exposed the substandard 2007 Alameda County Emergency Medical Services stroke transport protocol in an October letter in your publication, kudos go to Mayor Johnson, Interim City Manager Anne Marie Gallant, and the Alameda County Emergency Medical Services (ACEMS) Director Dale Fanning who all worked quickly – overriding the hospital’s protest – to get this changed in under two months. As of 12/1/2010, our ambulances transport stroke victims to certified stroke centers. Record time, I’d say!

The reason the stroke protocol was changed is because Alameda Hospital is NOT a stroke center, i.e., it’s not appropriate for ambulances to take stroke victims to Alameda Hospital. Federal and state stroke prevention and response standards dictate this, and it’s based upon the soundest of medical sciences.

People need to know that the recent statement made by Alameda Hospital CEO Deborah Stebbins explaining that, “the hospital will still get other stroke patients…who are outside the four-hour window in which drugs that reduce the symptoms of stroke may be administered,” makes no sense. Intravenous (IV) drug therapies are only effective the first four hours after a stroke. Interventions that work at/after four hours can only be found at a Certified Stroke Center: intra-arterial tPA and mechanical embolectomies. Also, there are several kinds of strokes; for some types, IV drug therapies are not appropriate. This is why a comprehensive stroke center is so important for ALL stroke victims.

Now I don’t know which is worse, the fact that “island stroke victims caught in the middle” may have been seriously harmed during the last three years. Or the fact that the hospital leadership (CEO and board) knew of this protocol, created business strategies around it, and recently staunchly defended it in attempts to stop the County from removing it (CEO Stebbins’ 11/19 three-page letter to Alameda County Health Care Services Agency defending the medically-substandard protocol, she concludes with a request to extend “the exemption for Alameda Hospital to receive stroke patients.”) This is a clear-cut case where our elected officials, and the CEO they hired, have put the business interests of the hospital above the health and well-being of Alamedans. Fortunately, the Alameda County EMS division stepped in to protect us by insisting that their most prudent stroke protocols now apply to us too.

— Denise Lai, Alameda

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