State Rep. Chris Lee regularly runs up Koko Head, goes hiking and hits the beach — a routine that has helped make him one of the most physically fit legislators at the state Capitol.

Not the image that comes to mind as a poster boy for stroke.

At age 30 he learned the hard way that stroke can happen to anyone, and fast action is crucial in preventing lasting damage.

Only about 6 percent of stroke patients in Hawaii get the clot-busting medicine that can spell recovery in some cases if given quickly, according to Dr. Matthew Koenig, chairman of the Hawaii Stroke Coalition. Lee was one of the lucky few, and emerged unscathed after a serious stroke four years ago, thanks largely to happenstance.

“The No. 1 reason people don’t get the medication is they don’t arrive in time to be treated,” said Koenig, associate medical director of neurocritical care at the Queen’s Medical Center. “You need to treat patients as soon as possible after symptom onset. When blood flow to the brain is blocked, you lose about 1.9 million neurons (brain cells) every minute.”

A push to improve stroke care in the islands is underway. A new law will ensure that hospitals enter details of their stroke cases in a joint database, allowing health officials here to pinpoint where treatment is falling short and figure out how to get patients the right care faster. The state is joining 31 others in launching a “stroke system of care,” which brings together hospitals, emergency medical services, government and organizations like the American Heart Association to quickly identify, transport and effectively treat patients.

In Lee’s case a happy set of circumstances got him help fast. Lee, who represents Kailua and Waimanalo, was talking to the Kailua Neighborhood Board one evening in November 2011 when he began to feel unwell. But he had no idea it might be a stroke.

“I’ve always been in pretty decent shape, and I never thought that anything like this would actually happen to me,” Lee recalled in an interview. “I started to feel a little bit sick, headache, lightheadedness, small loss of vision.”

He left for home in hopes of sleeping it off, but he never made it there.

“I got in the car and tried to drive and found I couldn’t even function coherently anymore,” he said. “I sort of coasted off the road, and I got really lucky. It was a fire station.”

Two girls happened to see him open his car door and “sort of roll” onto the ground, he said. They alerted the station crew, who jumped into action. Lee was whisked to Castle Medical Center, where he received a clot-busting drug.

“Because of that, I’m told, I was able to make a full recovery,” said the legislator, who had to spend a few days in the hospital.

In Hawaii, stroke is the third leading cause of death, after cancer and heart disease, according to the state Health Department. Nationally, it has fallen to fifth place in the past few years, according to a December report from the Centers for Disease Control, in part due to better care.

Stroke occurs when a clot blocks the supply of blood to the brain or when a blood vessel in the brain ruptures. Warning signs include sudden trouble speaking, seeing or walking; weakness or drooping in the face, arm or leg; or severe headache. The acronym FAST — for “face,” “arm,” “speech” and “time” — was developed to help people remember the symptoms and waste no time in calling 911. (See box.)

No self-deliveries

Often, bystanders don’t realize what’s happening, and patients might shrug off symptoms.

“Fifty percent of the time in Hawaii, stroke patients are self-delivering to the hospital,” said Don Weisman, Hawaii government relations director for the American Heart Association. “That’s the wrong thing to do. Not all hospitals are capable of providing the treatment you need.”

Instead, they should call an ambulance, which will rush them to the closest hospital that can best handle their case, he said. For example. a CT scan is needed to see whether the clot-busting drug is appropriate, but not every facility has a scanner immediately available. The drug, tissue plasminogen activator, or tPA, must be used within a few hours of the onset of symptoms.

“If you’re calling 911, they are diagnosing in the field, calling the hospital, making plans to bypass the emergency room and go straight to a CT scan if that’s appropriate,” Weisman said.

A Stroke Task Force that formed in 2013 became the Stroke Coalition and has already spurred better care. One initiative helped ensure paramedics are trained to identify stroke in the field using a standardized screening tool, which expedites treatment at the hospital, where every minute counts.

For 15 years Hawaii had just one hospital, the Queen’s Medical Center, certified as a “primary stroke center,” Koenig said. In the past two years, four others have earned that certification: Straub Clinic & Hospital, Pali Momi Medical Center, Wilcox on Kauai and Maui Memorial Medical Center.

The coalition, which represents a range of stakeholders, lobbied for the law that became Act 211 to improve stroke care. Hospitals will use the Heart Association’s national Get With the Guidelines-Stroke database, allowing the Health Department and the coalition to track and gauge progress of each facility and region, to learn from each other and better direct resources, including public education.

There are great disparities in stroke treatment across the Hawaiian Islands. Rural areas have less access to care, and certain populations such as Native Hawaiians and Filipinos are most at risk, Koenig said. The physician used billing data from the Hawaii Health Information Corp. to determine that just 6 percent of stroke patients in the state were treated with tPA, with the rate ranging from 1 percent to 12 percent among acute-care hospitals.

“Whether or not you get treated for stroke really doesn’t depend on your characteristics as a patient,” Koenig said. “It really depends on what ZIP code you’re standing in when you call 911.

“That’s really what this Stroke Coalition is designed to fix — that disparity in access to care for stroke patients.”

As a neurologist in the intensive care unit, Koenig sees the devastating disability stroke can cause. On the day he was interviewed, he admitted a patient who had stopped taking his blood pressure medicine and wound up with a cerebral hemorrhage.

“He felt the medications were making him dizzy,” Koenig said. “Now he’s permanently disabled from a brain hemorrhage. I admit patients like that several times a week. These can be people in their 30s and 40s.”

His message to the public: “Please check your blood pressure. The goal is less than 120 systolic blood pressure.” Untreated hypertension is common, even among young people, he said.

“People call it the silent killer,” said Koenig, a marathoner who takes blood pressure medicine himself. “There are really no symptoms associated with hypertension.”

Along with high blood pressure, risk factors for stroke include high cholesterol, obesity, diabetes, heart disease and smoking.

Some strokes have no clear cause. That was the case for Lee, who urges people to learn the warning signs so they can take quick action.

“It’s important not just for yourself, but to be able to recognize symptoms in others around you,” Lee said. “It could happen to anybody. You might be the person who might save a family member’s life or someone at work.”