A tale of two doctors
Dr. James Grotta, a professor of neurology at the University of Texas at Houston and director of the city’s stroke treatment program, asked Persse to help with organizing a citywide stroke program.

In June 2000, a partnership between stroke-treatment centers and in-the-field paramedics, the first of its kind in the nation, was established.

Persse retrained HFD paramedics to recognize the signs of a stroke, to collect the patient’s data and then relay the information for a doctor’s evaluation. One quick but reliable test has paramedics asking patients to smile. If the smile droops on one side, it is an indication of paralysis.

Time lost is brain lost
“We’ve got a saying we use in responding to stroke emergencies that reminds us to move quickly,” said Sr. Capt. Adrian Trevino, an HFD medical supervisor. “Time lost is brain lost.”

Trevino offers a simple analogy: “Think of a garden hose. Imagine the hose is an artery with blood flowing to the brain. Somewhere along the inside a small piece breaks away, gets lodged and stops the flow – that’s what an ischemic stroke does. And for every minute the flow is reduced, the more brain function is lost. Dissolve the blockage and it flows freely. That’s pretty much what happens when t-PA is injected.”

Trevino said that although HFD paramedics had been recognizing strokes for years, now they’ve received additional training in stroke procedures and how t-PA can arrest a stroke’s worst damage.

“I give all the credit to Drs. Persse and Grotta,” Trevino said. “They got the cooperative relationship working and incorporated paramedics down on the street level where the emergencies start.”

Stroke centers
Grotta, who pioneered the use of t-PA as a clot-busting antidote to ischemic strokes, established the designated stroke centers presently located at three hospitals: Memorial Hermann in the Texas Medical Center, St Luke’s and Memorial Hermann Southwest.

St. Luke’s and Memorial Hermann Southwest are primary stroke centers that provide basic stroke care including the use of t-PA.
Memorial Hermann-TMC, a comprehensive stroke center, provides not only the basic services but also complex rehabilitation therapies. Patients can enroll in advanced research programs aimed at preventing or reducing brain damage and disabilities from stroke.

At each designated stroke center, at least one stroke specialist is available 24 hours every day along with nurses and emergency-room personnel trained in stroke recognition and protocol, which includes CT scanning, t-PA therapy and the latest discoveries for protecting brain tissue.

“Houstonians can be proud to have access to state-of-the-science acute stroke care on their doorsteps,” said Grotta. “The working relationship between our centers and EMS paramedics serves as a model for the rest of the country.”

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"Try to squeeze my hand," says EMS paramedic Victor Mendez, left, as he and fellow paramedic Jimmy Ledbetter administer a stroke-recognition test. Photo by John Perry