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No 911 For Hispanics

 DALLAS - Mexican Americans are 40 percent less likely than non-Hispanic whites to call 9-1-1 and be taken to the hospital via ambulance for stroke — resulting in medical treatment delays — according to a new study reported in Stroke: Journal of the American Heart Association.

For the study, researchers used data from the Brain Attack Surveillance in Corpus Christi ( BASIC ) project to compare hospital arrival time and use of ambulance or emergency medical services ( EMS ) by ethnicity, gender and language preference among 1,134 Mexican Americans and non-Hispanic whites who had ischemic strokes between 2000 and 2006.  Subjects were ages 45 years and older; 53 percent Mexican American, 47 percent non-Hispanic white and 52 percent women.

The researchers found that 40 percent of Mexican Americans and 56 percent of whites called 9-1-1to access EMS.  Furthermore, 27 percent of Mexican Americans arrived at the hospital within three hours of stroke symptoms compared with 29 percent of non-Hispanic whites.

“We know calling 9-1-1 is important for getting prompt and appropriate treatment,” said Lewis B. Morgenstern, M.D., senior study author. “In this study, less than half of people use EMS for stroke.  That’s sobering.  Everyone should know we have effective treatments for stroke, so they must learn the symptoms and be motivated to call 9-1-1 if they occur.”

The study also found that women, particularly Mexican-American women, were significantly less likely to arrive at the hospital within the crucial three-hour time frame — when a clot-busting drug is approved for stroke treatment.  The difference may be because women are more likely to live alone and may not be as aware of stroke symptoms, researchers said.

“Living alone is a very important aspect,” said Morgenstern, director of the stroke program and professor of neurology, epidemiology, emergency medicine and neurosurgery at the Universityof Michigan, Ann Arbor.  “Many people with stroke fall down, have trouble speaking, can’t use their arms, have trouble getting to the phone.  So, more than 95 percent of the time, when 9-1-1 is called, someone else calls.”

More studies are needed to determine the differences based on ethnicity and gender, Morgenstern said.  Mexican Americans in the study were younger than non-Hispanic whites and less likely to have medical insurance; however, after adjusting for lack of insurance, researchers still found a noticeable difference in 9-1-1 usage.

“Stroke is an example of a severe disease that has a predilection for Mexican Americans and African Americans,” Morgenstern said.  “We are all responsible to try to eliminate those health disparities.  Minorities tend to have strokes at younger ages and it can be expensive to patients, families and our healthcare system.  We need more research into scientifically proven, appropriate ways to work within the community to prevent and treat stroke.”

Language did not impact whether stroke patients arrived via EMS or within three hours of stroke symptoms.  About 70 percent of the Mexican Americans studied spoke English or were bilingual ( English and Spanish ).

All people, regardless of ethnicity or gender, need to be aware of stroke symptoms and call 9-1-1 immediately when they occur, Morgenstern said.

He cited three reasons for EMS to take stroke patients to the hospital:

Patients arrive at the hospital faster. 
Most ambulances are required to call hospitals in advance when transporting a stroke patient, which mobilizes the hospital’s stroke team to ensure expert treatment. 
Doctors and nurses respond faster to patients arriving via ambulance. 
    Stroke symptoms are:

Sudden numbness or weakness of the 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 
“Stroke is a bad disease,” Morgenstern said.  “But it’s the most treatable of the bad diseases. Something can be done for ischemic stroke if you call 9-1-1 and get to the hospital in time.”

Co-authors include: Melinda A. Smith, Dr.PH.; Lynda D. Lisabeth, Ph.D.; and Frank Bonikowski, M.D. Individual author disclosures are on the manuscript.

The National Institutes of Health funded the study.



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