1) "Shotgun" Jackson had a stroke while working on his home in Missouri. His neighbor recognized the signs of stroke and called 911, beginning the chain of events that saved his life. 2) Jackson was transported via ambulance and helicopter to the regional stroke center within 3 hours of onset. There, doctors removed the clot from his brain using a catheter, restoring blood flow. 3) Despite having a severe stroke, Jackson recovered fully without long-term disabilities, due to the rapid response and coordinated emergency treatment he received. Community education on stroke signs is critical for initiating the lifesaving chain of events.

1. Steve Sanborn – Previously Published
Stroke: Now You See It – Now You Don’t
How a vital chain of events allowed a stroke victim to walk away unharmed
By Steve Sanborn
LifeFlight Eagle
“Shotgun” Jackson and his wife Carol of Independence, Missouri, last year made
a second home for themselves in Montrose, Missouri, a small community about
twenty miles southwest of Clinton. Jackson had retired from his semi trailer
repair business in April, 2003, and looked forward to working on his new home in
Montrose.
Then on October 23, 2003, as Jackson was stapling insulation to a wall in his
home in Montrose, his next door neighbor stopped by to pay a visit. Upon her
arrival, she took a good look at Jackson and said, “Shotgun, I think you’re having
a stroke.”
Thus began the first step in a chain of events that would save Jackson’s life and
restore his health completely.
As Jackson attempted to deny anything was wrong, Carol could plainly see
drooping on one side of the face, and Jackson’s speech was becoming slurred
and incomprehensible. Carol called 911.
“I just didn’t know anything was wrong at all,” Jackson said. “Thankfully, my
neighbor knew the signs of stroke. I could tell my speech was slurring, but other
than that, I had no pain. Had she not known what to look for, I don’t know where
I would be.”
The mystery of stroke has diminished significantly in recent years, allowing for a
level of awareness that may be easily shared with entire communities. Today,
with about five minutes of education, the average citizen can identify the
symptoms of stroke and start the chain of events that must occur to save the
stroke victim’s life and hopefully erase the physical damage brought on by the
lack of blood flow to the brain. This type of stroke is called acute ischemic stroke
(AIS) and represents 85% of all strokes. AIS is the leading cause of adult
disability in the United States.
The simple analogy anyone can understand is the clog in the drain pipe of the
kitchen or bathroom sink. We’ve all seen it time and again. Somewhere in the
house the pipe has been stopped up and depending on how bad the clog is, we
either pour a little Drano in to break it up or, if need be, we call Roto-Rooter to
drive a snaking device into the pipe to remove the clog.

2. Steve Sanborn – Previously Published
Essentially, a stroke is no different than a common clog in a pipe only the
plumbing system is in the brain. Now imagine if a clogged pipe in your house
could make a whole section of your house crumble to pieces. No doubt, you
would want to move quickly to fix the problem and prevent the damage. Apply
the same concept to your brain.
The household plumbing example essentially describes how most strokes occur.
A blockage (or clog) forms in the artery (or pipe) in some area of the brain,
cutting off vital blood flow to a section of the brain. This is what happened to a
portion of Jackson’s brain as he busily stapled insulation in his garage on
October 23, 2003.
This “basic plumbing problem” as Jackson refers to it, is the same cause for
heart attacks. A clot forms in an artery near the heart and stops blood flow and a
portion of the heart muscle begins to die because of the lack of oxygen to the
heart. Some stroke reversal experts like Dr. Marilyn Rymer, director of the Mid
America Brain and Stroke Institute at Saint Luke’s Hospital, refer to stroke as a
brain attack. In fact, the Brain Attack Coalition (BAC) formed several years ago to
establish criteria for Primary Stoke Centers like Saint Luke’s. Much of the stroke
intervention criteria are similar to trauma intervention.
"Stroke reversal treatment is time-dependent. Just as there is the ‘golden hour’
for trauma treatment, strokes treated within the first three hours after onset have
the best outcomes,” says Rymer.
Unlike many heart attacks, there is often little to no pain with a stroke. Often,
stroke victims don’t even know the problem is happening, which may be a
leading reason why the average stroke victim shows up at the hospital twelve
hours after the onset of a blockage. This is why it is so important for the whole
community to have an idea of what a stroke is and what it looks like, in order to
begin the chain of events that ultimately results in removing the blockage from
the artery inside a victim’s head, restoring life and health.
“First and foremost is the community’s ability to identify a stroke and realize that
everything from that point must move very quickly in order to correct the problem
and save the victim,” says Rymer.
What follows can be truly amazing.
For Jackson, everything fell into place in a perfectly coordinated sequence of
events that eventually brought him home to continue his retirement rather than to
live paralyzed in a nursing home for the rest of his life.
“I accidentally fell into the system in the right place and at the right time,” says
Jackson.

3. Steve Sanborn – Previously Published
The chain of events may vary for a given patient depending on the immediate
environment, location and severity of the stroke. But the entire process may be
said to have a “first half” and a “second half” which must happen flawlessly in
order to have a better chance at being completely effective. Both are equally and
vitally important, but logic dictates that the first half must happen first.
Consider Jackson’s case and observe that each necessary step in the “first half”
of his chain of events did in fact happen flawlessly and was not accidental at all.
Step 1: Identifying a stroke – Jackson’s stroke was identified due to the
effectiveness of basic stroke education.
Step 2: Local EMS identification of the stroke and specific emergency
action.
Despite the fact that most stroke victims will go or be taken to the closest medical
facility, Andrew Umland, then director of Ambulance Operations with Gold Valley
Memorial Hospital and now a flight paramedic with LifeFlight Eagle, immediately
knew that Jackson needed the Mid American Brain and Stroke Institute at Saint
Luke’s Hospital, because Saint Luke’s is the regional stroke center that provides
stroke reversal care 24-hours a day, 7 days a week. And because Saint Luke’s
is the nation’s leader in providing a new stroke reversal procedure that has given
exceedingly positive results to hundreds of stroke patients around the nation.
Step 3: Immediate Communication – Umland simultaneously notified LifeFlight
Eagle that an emergency transport was needed.
“Within two minutes of our arrival to Mr. Jackson’s home, we knew what was
going on,” says Umland. “Golden Valley Memorial Hospital protocol allows its
paramedics to determine on the spot what medical facility is appropriate for a
patient based on our assessment. Saint Luke’s was Jackson’s best possible
chance for a positive outcome. Additionally, getting Jackson there as quickly as
possible meant LifeFlight Eagle. We shaved at least forty five minutes off of the
overall timeframe by bypassing the local hospital. LifeFlight Eagle saved another
hour at least.”
Step 4: Rapid transport to a stroke center – Several minutes after Umland’s
call, Golden Valley Ambulance rendezvoused with LifeFlight Eagle in Deepwater,
Missouri. Jackson was moved into LifeFlight Eagle’s Bell 407 and whisked away
to the Mid America Brian and Stroke Institute at Saint Luke’s Hospital.
LifeFlight Eagle Crew members, Anne Marie Ondak (RN) and Kent Shutt
(paramedic) continued Jackson’s treatment in the air while Jeff Meyer (pilot)
transported him to Saint Luke’s at nearly 150 miles per hour.

4. Steve Sanborn – Previously Published
“Speed was the most important thing we could provide,” Ondak says. “Mr.
Jackson had a huge stroke. Had it occurred five or ten years earlier in my
career, he either would have died or would have spent the rest of his life
incapacitated in a nursing home.”
Thus ends the “first half” of Jackson’s lifesaving chain of events. For the best
possible outcome, these first four vital steps must happen within three hours of
the first signs of a stroke.
The arrival at Saint Luke’s via LifeFlight Eagle begins the “second half” and
ultimately provides the reason for why Jackson did not die or end up
incapacitated for life.
Steps 5 & 6: Assemble stroke team and assess patient – The moment Saint
Luke’s Hospital received the initial call from Umland, the stroke reversal team
was assembled in less than thirty minutes, made preparations for Jackson’s
arrival and stood ready to unload him at the Saint Luke’s helipad. From there
they would run a CAT Scan on his brain to determine the exact nature of his
problem and move him to the interventional neuro-radiology suite.
It is worth mentioning that Jackson did indeed have a “huge” stroke as Ondak
described. The National Institute of Health Stroke Scale is a numeric scale used
to determine the severity of a stroke. The higher the patient’s score the more
injurious the stroke.
“Anything over a 16 generally lands a patient in a nursing home,” said Rymer.
When Jackson arrived at Saint Luke’s his severity score was between 17 and 21.
The higher the score, the worse the stroke.
Step 7: Remove the clot – Upon arrival to the interventional neuro-radiology
suite, Naveed Akhtar, M.D, was ready to insert a catheter containing a Merci
Retriever, through Jackson’s groin and thread it up into his brain to identify the
blockage and miraculously remove it. Despite the absolute necessity of all the
previous steps, this last step is indeed the most incredible.
With the catheter poised in front of the clot in Jackson’s artery, Akhtar then
extended a small wire from within the catheter to pierce the clot. This small wire
is not made of any ordinary material. It is a combination of nickel and titanium
and has a memory of its own as it is able to resume a shape it has been
programmed to have. While the wire sits inside the catheter tube, it is straight.
Once it is extended out of the tube it resumes the shape of a coil or cork screw.
Having pierced the clot with the wire, Akhtar extended it out a bit further allowing
it to resume the cork screw shape, enabling Akhtar to torque or twist the coil into
the clot. From there, Akhtar slowly but surely pulled the whole clot out of

5. Steve Sanborn – Previously Published
Jackson’ artery immediately restoring blood flow to the oxygen starved section of
Jackson’s brain. At this point, Jackson’s stroke severity score dropped to a 4.
Three days later it was zero which means he is normal.
The concept of removing a clog from a pipe is simple enough. But as mentioned,
the pipe was in “Shotgun” Jackson’s brain. The process of “unclogging” it
requires years of instrument development, intense medical study and training,
natural talent and notable finesse. After all, we’re not talking about half inch steel
pipes one drives a Roto-Rooter snake into. Arterial blockages are found in very
delicate arteries often no more than three millimeters in width. Deadly blockages
can be smaller than a pin head.
Incidentally, the stroke reversal team also happened to identify a hole in
Jackson’s heart while treating his stroke. It seems the hole, which had always
been there, was the cause of the clotting problem which caused the stroke in his
brain. The next day, Saint Luke's Mid America Heart Institute cardiologist
Kenneth Huber, M.D., sent a catheter to Jackson’s heart, released a small rubber
sheath about the size of the fifty-cent piece, and covered the hole. Jackson went
home a new man.
“About twenty percent of us have a hole in our hearts that never closed from
birth,” says Rymer. This can cause clots to pass through the hole and into the
blood stream, though no one is quite sure what suddenly causes a blockage to
happen one day and not the day before.”
Several months later, LifeFlight Eagle began producing its documentary film,
LifeFlight Eagle: Your’s For Life. Jackson was asked to give an interview for the
film. Jackson did give the interview but initially replied that he was too busy with
other things.
“That’s about the best answer Mr. Jackson could have given,” said Ondak. “It
meant everything was back to normal for him.”
Know the signs and symptoms of stroke:
Sudden numbness or weakness of the face, arm or leg (especially on one side of
the body)
Sudden confusion, trouble speaking or understanding speech
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause

6. Steve Sanborn – Previously Published
The Stroke Test
If you suspect someone is having a stroke, call 911 immediately. While you’re on
the line with the 911 dispatcher or emergency medical technicians en route, ask
the patient to: Smile (look for a drooping on one side of the mouth or crooked
smile) -- Raise both arms and keep them up (look for weakness in one arm) --
Speak a simple sentence coherently (listen for slurring of speech). Report the
results to emergency personnel on the phone.