BY KRISTIN WEIDENBACH

Effective treatment for most medical emergencies hinges on getting the patient to a hospital as soon as possible. But for someone who has suffered a stroke, as soon as possible may not be soon enough. Emergency treatment generally must begin within three hours of the onset of stroke symptoms or the patient's long-term recovery may be severely compromised.

Gregory Albers, MD, professor of neurology and neurological sciences and director of the Stanford Stroke Center, is working to ensure that residents of Santa Clara County have the best possible chance of fully recovering from a stroke. He is the leader of "Operation Stroke" for the county. Operation Stroke is a nationwide program to educate and inform local communities about how to treat and prevent stroke. The American Stroke Association, under the auspices of the American Heart Association, administers the program.

There are two major categories of stroke, or "brain attack." The majority of stroke patients fall victim to an ischemic stroke in which blood flow to the brain is disrupted by a blood-vessel blockage. Tissue plasminogen activator, or tPA, is a drug that can dissolve the blood clots that commonly cause these blockages and restore blood flow to the brain. Prompt treatment with tPA can minimize or prevent long-term neurological disability from stroke, such as impaired speech and loss of muscle control. But it must be administered within three hours of the onset of symptoms. After this time, tPA treatment is no longer effective for most patients and the risk of bleeding in the brain increases.

The remaining 10-15 percent of strokes are classified as hemorrhagic strokes in which a blood vessel in the brain bursts. In these cases, tPA should not be given to patients because the drug escalates the bleeding and worsens the condition.

Albers has solicited medical professionals and hospital administrators from all of the hospitals in Santa Clara County to join the Operation Stroke Task Force. Representatives from Stanford Hospital, O'Connor Hospital, Good Samaritan Hospital, Santa Clara Fire Department, Kaiser Hospital and the Peninsula Stroke Association, among others, attend task force meetings and comprise the four subcommittees focusing on community education, paramedics and emergency personnel, medical services and public relations. Participation of community members and paramedical professionals is also key to achieving the goals of the task force.

The message Albers wants to relay to the residents of Palo Alto, San Jose and all the towns in between is: "'We want to improve stroke treatment in your community.' That's the goal," said Albers. But to achieve this the task force first must ask: "What does your community need?"

The program was publicly launched in October but the task force has been hard at work since last February instigating studies and collecting data. Members of the task force have almost finished collecting data on 20 consecutive stroke patients and 10 consecutive "ministroke" patients at each of the county's hospitals. "We want to see what's happening to stroke patients being treated at all hospitals in the county," said Albers.

The team also plans a larger study looking specifically at stroke patients who make it to a hospital within the three-hour time window. "We'd like to look at how many stroke patients arrive within three hours at each hospital, how many are treated with tPA and what the results are," said Albers. The study will be modeled on one that analyzed treatment of almost 4,000 stroke patients over a one-year period at 29 hospitals in the Cleveland metropolitan area. The study found that 17 percent of the patients were admitted to a hospital within three hours but fewer than 2 percent (70 patients) were given tPA.

"The Cleveland study found very different standards at different hospitals," said Albers. "A large number of patients could've been treated with -- but didn't get -- tPA and of the 70 patients who did get it, 50 percent had a major error made in their treatment. We're concerned that that could be the case with some of our hospitals so we're working to get a similar survey done here."

Albers said preliminary data from the Santa Clara Valley indicates approximately 25 percent of stroke patients get to a hospital within three hours and about half of the patients should be eligible for tPA. But until a formal study is done, such as the one that Albers' task force hopes to instigate, it is impossible to know how many stroke patients in the area may be missing out on tPA treatment.

A survey of paramedical services has also been launched under the auspices of the task force. Paramedics are a critical part of the program because they are the first to diagnose a stroke patient and also the ones who ferry the patient to the emergency room. "Paramedic policy is, 'We take you to the closest hospital that can handle your disease.' Right now they don't know which hospital that is," said Albers. It may be better for a stroke patient to be diverted to a more distant hospital for prompt evaluation and treatment, if appropriate, as opposed to being taken to the closest hospital, which may not be poised for tPA administration.

To ensure the best possible treatment for patients, paramedics must accurately diagnose stroke. Patients considered eligible for tPA should be transported to the nearest hospital capable of offering emergency stroke evaluation and treatment. Preliminary data from the task force indicates local paramedics already are more than 90 percent accurate in diagnosing strokes. But satisfying the second requirement -- knowing which hospitals are appropriate stroke-treatment centers -- will be more difficult.

"The diversion idea is politically sensitive," Albers admitted. "We would much rather see every hospital in the county able to treat stroke effectively. However, if some hospitals are unable to organize an effective stroke-treatment protocol, then diversion of the 25 to 30 percent of patients who have the chance to get the drug should be considered."