UCLA emergency room staff know that every minute counts when it comes to treating patients who have suffered from a stroke.
“Time is brain.”

With these words, UCLA professor of emergency medicine and neurology Dr. Sidney Starkman captures the tick-tick-ticking of the crucial minutes following a stroke — a blood clot or rupture of a blood vessel in the brain. 

“It’s not just a time clock,” Starkman said. “It’s also a tissue clock,” precious brain cells deprived of nourishment ticking off to death in a matter of hours, brain cells responsible for our ability to speak and move, think and feel.

This is where Starkman’s 25-student, all-volunteer Stroke Team comes in. Seven days a week, from 8 a.m. to midnight, team members, who are primarily pre-med students, don white lab coats and work side-by-side with emergency room doctors and nurses at Ronald Reagan UCLA Medical Center to ensure prompt treatment of stroke patients.

As recently as two decades ago, medicine had few options for treating stroke. But the prognosis has greatly improved, thanks to research leading to clot-busting medication and surgical procedures that can minimize brain damage and sometimes prevent it altogether. But successful outcomes depend on timely treatment — ideally, within the first hour or two after the stroke occurs.

Dr. Sidney Starkman, professor of emergency medicine and neurology, created the Stroke Team to work side-by-side with staff in the ER.
To help save lives by saving time, Starkman, co-director of the UCLA Stroke Center and head of the Geffen School of Medicine’s emergency neurology training program, gets valuable assistance from the Stroke Team, which he launched in 1992.

“They are my eyes and ears in the ER,” said Starkman, who is on call 24/7 to oversee the diagnosis and treatment of patients suffering from stroke or other neurological conditions. Stroke Team members, selected by Starkman from hundreds of students who vie for a coveted spot each year, undergo intensive training to develop expertise in evaluating stroke patients.

This includes identifying patients who may be having a stroke but don’t know it. Strokes — unlike heart attacks which often present painfully and dramatically — are usually painless. And many people aren’t familiar with the danger signs of stroke, which include a sudden inability to walk, talk, see the world normally, or use or feel a part of the body. Sometimes patients brought to the ER after a seizure or a fall may actually be suffering the aftermath of a stroke.

Amidst the crush of patients in the ER for everything from car accidents to premature birth, staff turn to Stroke Team students to speed the process of identifying stroke patients.

“We might ask, ‘Are you able to walk? Do your left and right sides feel the same?’” said Linda Ye, who served on the Stroke Team for two years before graduating from UCLA last June. Or, taking a family member aside, she might inquire, “Does your mom’s smile look normal? Is she talking like she normally talks?”

“We’re working with really great physicians, so we never have to come in and save the day,” said Stroke Team member Victor Tran. “But we do expedite the care of stroke patients. With brain ischemia [brain blood clot] being such a time-sensitive injury, our role speeds things up, which can make a huge difference in a patient’s outcome.”

Serving on the Strike Team, say alumni Amrit Ahluwalia (from the left), Linda Ye and Victor Tran, solidified their desire to become physicians. All three have applied to medical school.
Identifying a potential stroke patient prompts a phone call by the student to Starkman, who determines next steps, from sending the patient to radiology for brain imaging to pulling in the Stroke Center’s Brain Attack Team. Stroke Team students pitch in wherever they’re needed — rushing patients to imaging, collecting medical history from family members and helping fill out paperwork.

“Even the small tasks can be such a profound thing,” said Amrit Ahluwalia, who joined the team during his last year as a computer science engineering student. He recalled an incident when a stroke patient had been rushed to the ER from his workplace, and the physician needed to contact the man’s wife.

“Obviously, everybody was rushing to help the patient,” Ahluwalia said. “I was able to locate the husband’s ID with a home address. From that, I found the home phone number and was able to reach the man’s wife for the physician. That really helped expedite things.”

“They are invisible, but invaluable,” Starkman said of the team. “Their presence also heightens awareness of stroke in the ER, reminding everyone that stroke is an important issue.”

Dr. Jeffrey Saver, professor of neurology and director of the UCLA Stroke Center, looks at brain scans with team members.
Also helping to make L.A. communities more stroke-aware is the Stroke Force, UCLA students who put in shifts in the ER and also make presentations just about every Sunday at senior centers and other community sites. Their mantra: Call 911 immediately.

Students on the Stroke Team and Stroke Force earn credit for hospital volunteer and community service hours. They also earn credit in UCLA’s Student Research Program because their primary job is to connect stroke patients in the ER to clinical trials for new treatments such as the neuroprotective drugs that can slow brain cell death from stroke.

But well beyond credits earned, Starkman noted, students serve on the team for the education and experience it offers.

“They learn all about stroke, about neurology and the brain,” Starkman said. “They learn how to approach patients and families, and about everything that has to be done for a patient.” And they learn firsthand, from viewing brain scans with an attending physician to watching an interventional radiologist thread an endoscopic fiber through a patient’s blood vessel to extract a clot with a tiny “corkscrew.” Twice each quarter, Stroke Team students also join Neuro Rounds at the hospital, tagging along with neurology fellows and residents as they visit stroke patients.

Click to see full-size image.
“It was the most rewarding activity I’ve ever done in my undergraduate career,” said Tran, who, like Ye, graduated last year and is waiting to hear about medical school. “We get to listen in and observe what I feel is the most comprehensive stroke care in the world … and we’re not just there to make patients more comfortable, but are actually contributing to their health.

“It’s the best experience you can have to determine whether or not you want to become a doctor,” said Tran, who noted that the program pointed him toward neurology.

“I’m just fortunate to have this program with all these wonderful kids,” said Starkman. “They’re very smart. They’re very talented.”

Many of these “kids” — some 200 have served on the Stroke Team during its nearly 20-year history — have gone on to become physicians, UCLA residents and even faculty in emergency medicine and neurology. Many former students send Starkman notes thanking him for an experience that changed their lives.

“Without this program,” one wrote, “I probably would have never really figured out that I wanted to do medicine.”