When Dick Ehinger began having difficulty swallowing and slurring his speech while watching a football game last Thanksgiving, his family sensed something was wrong almost immediately.

His wife tried talking to him and got very little response. When she reached for his hand, it just dropped.

One in 10 persons over age 65 (and nearly half of persons over age 85) are affected by Alzheimer's

Their daughter, a nurse, and son-in-law, a cardiologist, visiting from out of town, went into quick action and called 911. They thought Ehinger was having a stroke and knew that he needed to be seen within a three-hour window in order to administer tissue plasminogen activator (tPA) – a drug that uses an enzyme in your own blood to dissolve the clot causing the stroke.

Ehinger went straight to the Charles F. Knight Emergency and Trauma Center at Barnes-Jewish Hospital where tPA was administered immediately. Thanks to the timely response, he went from someone who was incoherent to back to his former self. "By the time I was leaving the emergency department for the ICU, I could speak clearly and my family felt better about my condition," he says.

Recognizing Barnes-Jewish Hospital''s efforts to ensure better outcomes for stroke patients, the Joint Commission on Accreditation for Healthcare Organizations (JCAHO) certified Barnes-Jewish as a Primary Stroke Center – the first hospital in the St. Louis area to receive the honor.

JCAHO is an independent, not-for-profit organization and is the nation''s predominant standards setting and accrediting body in health care. Overall, they evaluate more than 15,000 organizations and programs in the United States.

Abdullah Nassief, MD, Washington University neurologist and director of the stroke center at Barnes-Jewish Hospital, says earning this accreditation is a big step for stroke treatment in St. Louis. "We have an excellent team here and Barnes-Jewish has dedicated resources needed to help stroke patients and to help integrate them back into the community," Dr. Nassief says.

The Joint Commission''s Certificate of Distinction for Primary Stroke Centers recognizes centers like Barnes-Jewish that make exceptional efforts to foster better outcomes for stroke care. According to Dr. Nassief, part of that effort is because of the stroke center''s mantra: "Time is Brain."

The phrase means that if someone is having a stroke, there is a very limited amount of time to get treated before an onset of permanent problems can set in. Barnes-Jewish''s stroke center coined the term in the mid-90''s and it has now gone nationwide. Dr. Nassief says there''s a greater emphasis on stroke by emergency personnel, who a decade ago, didn''t treat stroke as quickly.

"It was an interesting shift," says Dr. Nassief. "People used to view stroke as a non emergency -- this person had a stroke there is nothing that we can do for them -- to where this is an ultra emergency just like a heart attack, and there''s a team that is ready to take care of them once they walk in the door."

The team at Barnes-Jewish Hospital and Washington University School of Medicine is part of a growing number of Primary Stroke Centers in the country. These centers are trained in using tPA Dr. Nassief says its FDA-approval in 1995, revolutionized stroke treatment.

However, not all hospitals are trained at using tPA, and most people do not know which hospital uses the drug. Since "Time is Brain," people should call 911 to get to the nearest Primary Stroke Center at the first signs of stroke symptoms. Ambulance crews are aware of the hospitals that administer this brain-saving treatment. "That can be very disheartening for us because we know we could''ve helped them if they came to our service earlier," Dr. Nassief says.

Achievement of certification as a Primary Stroke Center signifies that the services at Barnes-Jewish Hospital have the critical elements to achieve long-term success in improving outcomes. The Joint Commission''s Primary Stroke Center Certification Program is based on the Recommendations for Primary Stroke Centers published by the Brain Attack Coalition and American Stroke Association statements for stroke to evaluate hospitals functioning as primary stroke centers.

Since his stroke, Ehinger has not had any complications. "I really believe knowledge is the key to this whole thing," he says. "Time was critical and it made all the difference to my success."