When Richard Chew woke up one Thursday morning feeling “a weakness” on the right side of his body, he didn't think it was anything out of the ordinary.

“I tried to grab onto my bed but I slipped to the floor,” the 57-year-old retiree recalled.

“So I told my wife, I think I'm still quite okay,” Mr Chew said matter-of-factly. “Then she said, okay you take care, and went on to work.

“I was thinking, for whatever reason, I have this weakness and it may go away at night.”

But when his wife came home from work that evening, she noticed that the features on the right side of his face “were twisted”, and his speech had become slurred.

These were the typical signs of a stroke.

“We didn't know how to react to this," said Mr Chew. "Of course, the first thing is to go to the hospital. But should we go straight?”

Eventually, they decided to go to Singapore General Hospital’s accident and emergency department (A&E), but in their own car, driven by Mrs Chew.

When they reached the hospital, they had to register and go through triage, before the A&E nurse found out that Mr Chew has had a stroke and immediately activated the acute stroke team.

By the time the team attended to Mr Chew, more than 12 hours had passed since the time he woke up with that tell-tale "weakness".

Due to the delay, the team couldn't administer treatments which would have helped him if they were administered within six hours after onset of the symptoms. He was sent to the stroke unit for monitoring to prevent further complications. 

Fast forward three months, Mr Chew is now wheelchair-bound and unable to use cutlery with his right hand.

It was only after his experience that he realised that he had made two mistakes - not going to the hospital immediately, and going to the A&E by car.

While more patients are arriving at the hospital "early enough" for timely treatment since the first Spot Stroke campaign in 2016, only around 50 to 60 per cent came in by ambulance

72-year-old Tan Mong Huat was luckier than Mr Chew.

Last year, the former Grab driver was ferrying a passenger from Jurong to Labrador Park when his vehicle crashed into a lamp post.

"At first I thought my car tyre was punctured," said Mr Tan. "But luckily my customer was alert and saw that I might have (had) a stroke. He asked me not to move and immediately called the ambulance."

SCDF paramedics arrived within 10 minutes and he was sent to National University Hospital where he was given the clot-busting medication.

As a result of that timely intervention, he suffers no side-effects or disability from the stroke. 

When asked what he would have done if he were alone, Mr Tan replied: "I would not know, that was the first time I suffered a stroke and I don't know the symptoms."

"I want to express my heartfelt gratitude towards the passenger who called 995, the SCDF paramedics and the hospital’s acute stroke team. Their actions had contributed to a better outcome for me and my condition would have been more serious without their prompt response."

"TIME IS BRAIN"

​​A stroke occurs when a part of the brain gets damaged due to an interruption in its blood supply. When brain cells die because they do not receive oxygen from blood, it is irreversible.

Stroke remains the fourth leading cause of death in Singapore and one of the top contributors of adult disability.

In the treatment of acute stroke, the team’s priority is to save the brain tissue that hasn’t died, which in turn saves body function and the patient's quality of life in the long run.

“If you ask me, the better term is time is brain," said Dr De Silva. 

The more time we lose, the more brain we're losing.

For the team, the clock starts ticking not when the patients passed through the doors of the hospital, but when they first experienced the symptoms.

The most common signs of a stroke are sudden drooping of one side of the face, weakness of one side of the body and difficulty speaking or understanding speech.

There's a bit of “detective work” involved in pinpointing when the symptoms first appeared, said NNI Advance Practice Nurse Il Fan.

“The patient’s history is the most important thing that we want to find out when they arrive," said Il Fan. "Sometimes if patients come in unable to talk, we go to the extent of checking their phone to trace their last conversations and find out (the last time) they were well.”

"If the SCDF (paramedics) can actually give us a lot of information then it will be helpful, because sometimes even though passers-by witness it, they don’t come together with the patient to the emergency department.”

“When we receive a notification that there is a stroke case (inbound), we will go down to the emergency department,” said Il Fan as she quickened her pace to the basement where the resuscitation area is located.