What stood out about this incident wasn’t only the media misdiagnosis, but also the fact that the victim suffered from the attack in a public place in full view of many passers-by, most of whom were unable to offer any assistance whatsoever. Few members of the public in Ho Chi Minh City have the basic medical awareness needed to help in an emergency.
As emergency medical director at Family Medical Practice, I have been an integral part of the development of Ho Chi Minh City’s first private emergency medical response system, EMR *9999. While in this case the unit was able to respond immediately to the call for help, after a bystander dialed the emergency number, I remain very concerned about spreading awareness in Ho Chi Minh City about the basic protocols needed to deal with medical crises. It’s mostly a lack of understanding that makes bystanders hesitant to act, resulting in delays that often cost lives.
Stroke or Heart Attack?
The differences between a stroke and a heart attack are easy to recognise, and in the moments leading up to a cardiac incident, there are several clues that can identify what the problem is likely to be.
A stroke is a cardiovascular accident in the brain. If a blood vessel supplying blood to the brain gets clotted, that’s called an ischemic stroke. Ischemic means that the brain doesn’t get enough blood. If the vessel is bleeding, that’s called a haemorrhagic stroke.
Both kinds of stroke occur in the brain, leading to a neurological defect. You have slurred speech, you can’t pronounce words, you cannot raise your hand; you can feel a tingling numbness, until you go into a coma. So if you see signs associated with neurological defects, that’s a stroke.
Heart attacks are different. If you have chest pain, discomfort in the chest, in the upper part of the body, that is the beginning of a heart attack. You will often see someone clutching at their chest, complaining of difficulty breathing, or breaking out into a cold sweat.
The function of the heart is to pump blood throughout the body, and if it doesn’t pump enough to the brain, then the brain gets involved. The patient will then also go into a coma. At that point, it can be confused with a stroke.
In either case, the response of a bystander should be the same — they should call for medical help. I urge people in this situation to dial our emergency number *9999, because you will get free and proper instruction. The call-taker will question you and then lead you through the correct course of action.
One issue that proved difficult in setting up a 911-style emergency response system in Vietnam, is that there is a degree of scepticism about the usefulness of medical instruction over the phone, especially in the case of life-saving techniques such as cardiopulmonary resuscitation (CPR).
For people in Vietnam, it seems too new, but people can really do it — this has been proven in America and all over the world. The most important thing is not to panic, and to call for instructions. If you call the emergency line, the question and response protocols can give you the best assessment possible.
CPR is an essential first response in cases of cardiac arrest, and I would advise everybody to learn it — we run a monthly course in FMP’s District 2 clinic instructing in this technique — but if you don’t know CPR, call *9999, and the call-taker will talk you through it.
In cases of an ischemic stroke, prompt medical response can be very effective. If a victim can be taken to hospital within the first three hours of the incident, we can administer a blood clot-dissolving medication called tPA (Tissue Plasminogen Activator) that is able to restore the blood flow. In our clinic we have had three cases already. You can see the patients come in with hemiplegia — paralysis of half the body, and within five to six hours, they can walk.
In all events, time is the most critical component. Whether or not you know CPR or have enough information about the victim to be able to figure out what has happened, call *9999 within Saigon for professional emergency assistance and stay calm. The speed of your response is likely to be the difference between life and death.
Dr. Bui Nghia Thinh is the Emergency Medical Director of EMR *9999. For more information on FMP’s emergency response service, click on star9999.vn