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The Stroke 120 campaign uses the medical emergency number in China to represent three steps to check for symptoms. Photo: Handout

Shanghai campaign reduced delays in stroke patients getting to hospital, team says

  • After the Stroke 120 programme was launched in 2016, median delay time fell from 19 to six hours, according to study
  • It aims to educate the public on how to recognise a stroke and to call for an ambulance if there are symptoms

An education campaign in Shanghai has helped to reduce delays in people getting to hospital when they suffer a stroke, highlighting the importance of effective public health messaging, according to the researchers behind it.

The Stroke 120 programme was launched in the city in 2016 to educate the public on how to recognise a stroke and to call for an ambulance if there are symptoms.

It uses the 120 medical emergency number in China to represent three steps to check for stroke symptoms: 1 is to look for facial asymmetry; 2 is to see if the arms are weak; and 0 – pronounced the same as “listen” in Chinese – is to check if the person can speak clearly.

The campaign involved a one-minute clip broadcast six times a day on local television and radio stations, as well as weekly public talks by doctors and monthly advertisements in newspapers.

“More patients with mild stroke were admitted to the hospital after the campaign, suggesting patients and their family members were more alert to stroke symptoms and sought care even when the symptoms were mild,” the researchers wrote in a paper published in the peer-reviewed journal JAMA Network Open on Tuesday.

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They found that the median hospital arrival delay time dropped from 19 to six hours, with one-third of patients arriving within three hours, compared to 6 per cent before the campaign.

The use of ambulances to get people suffering a stroke to hospital also jumped from 3 per cent to 30 per cent.

Stroke patients treated with drugs for blood clots within three hours of the first symptom had a substantially lower disability rate compared with those whose treatment was delayed, according to the paper.

The team based their analysis on data collected between 2016 and 2019 from more than 2,850 patients who had suffered an ischaemic stroke – the most common type, caused by a blood clot blocking the supply of blood and oxygen to the brain.

All of the patients had been treated at Minhang Hospital, which is affiliated with Fudan University and is the only health facility with a stroke centre in Shanghai’s Xinzhuang county.

Zhao Jing, a neurologist at the hospital who proposed the education campaign and co-authored the study, said the drive had effectively reduced the stigma of calling for an ambulance.

“Many people were reluctant to call 120 because they felt ashamed when an ambulance arrived at their building,” Zhao said. “They were worried about what their neighbours would think, so they would rather go to hospital by other means of transport.”

She said the campaign was being expanded to 16 other mainland Chinese cities over the next two years to reduce delays getting to hospital after a stroke and increase the three-hour arrival rate.

Stroke is a leading cause of death in China, resulting in more than 1.5 million deaths every year. The mortality rate for stroke in the country is five times that of Europe and the United States.

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The Chinese Stroke 120 programme was developed by adapting the Face Arm Speech Time (FAST) programme commonly used in English-speaking countries.

Study co-author Liu Renyu, who launched the Chinese campaign with Zhao, said non-English speaking populations would find it hard to understand the FAST acronym, so he was using the 120 approach in other places.

“Our strategy is simple – link stroke symptoms with the local emergency number to overcome the language barrier,” said Liu, a professor of anaesthesiology and critical care and neurology at the University of Pennsylvania in the US.

For example, for Chinese living in the US and Canada where the emergency number is 911, the slogan is “Stroke 911” – but the message to check the face, arms and call the emergency number when they find abnormalities is the same, Liu said.

China saw a 40 per cent drop in stroke-related hospital admissions during the initial Covid-19 outbreak in 2020 compared to the same period in 2019, according to a 2020 peer-reviewed study by Zhao and Liu. They found that most stroke centres had stopped or cut back their public education efforts after stroke care was reduced in most hospitals.