Mobile Stroke Care Units Improve Treatment

Mobile stroke treatment units can cut time to therapy in half.

Researchers have created a mobile stroke treatment unit in the form of an ambulance equipped with telemedicine technology and a CT scanner, which are critical for these patients.

The treatment unit will be serving an area in Illinois, and will be 1 of the few units of its kind, according to a press release from Rush University Medical Center. Stroke team members will also be working with local fire chiefs and emergency services to create protocols for emergencies in the Chicago area.

An accurate diagnosis, including neurological assessment and CT scan, is critical for stroke treatment. Treatment is needed shortly after a stroke is experienced in order for the care to be effective.

“Presently patients cannot be treated for their stroke until they get to an emergency room,” said Dr. James Conners, MD, MS, medical director of the Mobile Stroke Unit. “This new mobile stroke treatment unit will bring immediate stroke diagnosis and treatment to patients at their homes, or wherever they’re in need, which will improve their chances of a good recovery.”

If care is delayed or proper treatment is not received, strokes could be fatal. By creating a mobile unit, better care and better outcomes are expected.

“We will have the ability to check patients in their own homes and driveways for bleeding in the brain or blockage in their blood vessels,” said Demetrius Lopes, MD, surgical director of the Rush Comprehensive Stroke Center. “This ability is crucial, since stroke treatment decisions depend on CT imaging of the brain.”

If there is a report of stroke-like symptoms in a 911 call, the mobile treatment center will respond along with a regular ambulance, according to the University.

If a stroke is suspected, first responders will perform CT scans, and neurologists at Rush University Medical Center will evaluate patients and make treatment decision through the use of the telemedicine technology.

The emergency medical technician and nurse staff will administer stroke medication requested by the neurologist, all while the patient is being taken to a stroke center. The standard treatment for ischemic strokes is called plasminogen activator (tPA), which dissolves clots in blood vessels in the brain that caused the stroke.

The drug restores blood flow and oxygen to the brain, so death and disability will be prevented. However, ideal administration of tPA is within 90 minutes of the stroke occurrence. After 4.5 hours, administering the drug has no effect on patient outcomes.

"We know patients are up to 4 times more likely to have a good outcome if they are treated with tPA. Also, the sooner we treat patients, the more likely it is they will have minimal or even no disability,” Dr Conners said. “With our standard process, it’s rare to be able to treat people within the first hour after onset, but with the Mobile Stroke Unit we anticipate even better outcomes.”

Due to the narrow treatment window, only a small amount of patients are treated with tPA. For patients who experience severe strokes, fast treatment with tPA may not be enough to prevent death and disabilities.

“When someone has a bad stroke that is a large vessel occlusion (blockage) that doesn’t respond to tPA, it’s crucial that the patient be taken immediately to a comprehensive stroke center like Rush,” Dr Lopes said.

For these patients, a thrombectomy to remove the blockage in the brain is crucial. Only comprehensive stroke centers are staffed with neuroendovascular surgeons able to perform these procedures. In the Chicago area, there are only 6 centers, including Rush University Medical Center, that offer the procedure.

By diagnosing the patient immediately, the first responders are able to transport the patient to an appropriate facility.

“If you’re not assessing patients in the field, you’re missing an opportunity. If patients who need thrombectomy aren’t taken directly to a comprehensive center, it will cause significant delays in their receiving the care they need,” Dr Lopes said. “The CT in the Mobile Stroke Unit will allow us not only to obtain brain but also blood vessel pictures. This information is essential to determine the level of care the patient needs.”

Patients who experience a hemorrhagic stroke can also benefit from the mobile unit. These patients, whose blood vessels leak or burst, cannot receive tPA since it could be fatal.

“With the CT scan, the mobile stroke team can separate the bleeding strokes in the brain from the blockage strokes,” Dr Lopes said. “If it’s a bleeding stroke, we can initiate measures in the field to control blood pressure, optimize patient coagulation and alert the surgical team in the hospital to get ready. It can be life-saving if you’re able to get to the hospital and get the patient right into surgery and alleviate the pressure on the brain.”

The goal of this new program is to capture 75% of strokes in time to deliver beneficial treatments for the patients, according to the press release. Rush University Medical Center will also be conducting an educational outreach program that focuses on recognizing and responding to stroke symptoms.

"We've been trying to cut down the 'door to needle times' — the time it takes a patient to be treated in the emergency room — as much as possible,” Dr Conners said.

Other mobile units have been found to reduce the time between the onset of the stroke to treatment by 50%, with most treated within 30 minutes. Participants in Rush University’s Mobile Stroke Unit hope to see similar successes.