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 While Waiting for the Ambulance ...(first aid for stroke patients
            and techniques for induced hypothermia)
Saturday Evening Post, March 2001 v273 i2 p47.
Paul SerVaas
      Full Text COPYRIGHT 2001 Saturday Evening Post Society

If you think you are having a stroke, don't wait to see if your symptoms get
better. Call 911. And then call your doctor.

Stroke symptoms vary based on where in your brain the stroke has occurred.
Feelings of numbness or weakness are common symptoms, especially if they occur
on just one side of the body. Other symptoms include difficulty speaking,
understanding, seeing, and walking. Dizziness and severe headache can also be
signs of a stroke.

Recent medical research suggests that slightly lowering a stroke victim's body
temperature (say, from 98.6 degrees F to 96 degrees F) can improve the
patient's "outcome." (Outcome here is defined as whether the victim lives and,
if so, with how much brain function.)

Based on the two adjacent expert interviews, it would seem reasonable that
people who suspect they have had a stroke attempt to cool themselves while
waiting for (and riding in) the ambulance. People at high risk of stroke might
consider keeping homemade "ice blankets" rolled up in home freezers.

Before buying an ice blanket, talk to your doctor. If advised to attempt
post-stroke, pre-hospital cooling, ask for a target body temperature. (You
might also ask whether he/she recommends that you take all or part of an
aspirin when stroke symptoms strike.)

The pictured ice blankets were cut to body length from a 16-inch-wide by
17-foot-long roll of Insul-Ice[TM]. (This refreezeable ice mat can be
purchased from Polyfoam Packers Corporation for $55.00 by calling
1-800-323-7442. Ask for Model 405H.)

In our tests, we found that you could easily cut the Insul-Ice mat into useful
lengths and shapes without popping the liquid/ice cells. Once frozen, sections
of mat can be held around the victim using string, duct tape, or Velcro[TM]
straps. The victim's body weight will not pop the mat's cells.

Be sure to cut the bottom blanket longer than the top, so you can roll up two
feet of it to form an icy pillow for the victim's head and neck.

Make everyone in your household aware of your emergency plan. If you suffer a
severe stroke, you will not be able to chill yourself or direct others to do so.

Keep an ear thermometer--available at any drug store--handy to let you (or
your assistant) know when your doctor's target temperature has been reached.

If the ambulance responds quickly, it is doubtful you will ever go below your
target temperature while enroute to the hospital. If you do, simply remove
some of the ice blankets. It is more likely you will have trouble reaching the
target temperature. You may need to remove some outer clothing. By all means,
remove the shoes and wrap the feet in small pre-cut sections of ice blanket.
If the person is overweight, you may need to sprinkle water on the wrapped
victim in order to reach the target temperature.

Find out if your local hospital can keep stroke patients cool. If the hospital
does not have hypothermia equipment for this purpose, you and your doctor need
to make a plan. For example, you may want to purchase two boxes of Insul-Ice
and bring all 34 feet of the cut-up material to the hospital. As blankets
thaw, your doctor can order blanket sections rotated between bedside and the
hospital freezer. With two boxes on hand, you and your doctor will at least
have the possibility of continuously inducing mild hypothermia for the 10 to
72 hours discussed in the accompanying interviews. Note that patients
undergoing prolonged, induced hypothermia in recent hospital trials have been
sedated with pethidine (also known as Demerol[R]) to control their shivering.
Be prepared to ask your doctor for appropriate sedation.

There is no evidence that inducing mild hypothermia in stroke victims can hurt
them. On the other hand, doing so might benefit them enormously for the rest
of their lives. It may even save their lives. Until more studies are
completed, however, you and your doctor are on your own. Hospitals do not
routinely provide this service.

Currently, too many stroke victims suffer in denial for hours before conceding
that they have had a "brain attack." This is sad and tragic. There is much
that physicians can do to save lives and brain function--but only if you
arrive in time. (See "Striking Out Against Stroke" in the Jan./Feb. 2001 SEP.)

If storing ice blankets in the freezer does nothing more than routinely remind
future stroke victims to act quickly when stroke symptoms hit, it seems worth
doing. It might also remind them to maintain a stroke-preventing diet when
they open their freezers.

The Post would appreciate hearing from any reader who attempted to induce mild
hypothermia after suffering stroke symptoms. Look for updates in future issues
of the Post or on our website ( www.satevepost.org).
                                        -- End --