BY SARAH SONG, MD, MPH
The stroke center where I work just got a mobile stroke unit—one of a handful in the country—and I am so excited. This miniature emergency department on wheels lets us bring stroke care right to your door by ambulance, and helps us reduce the time between the appearance of symptoms and medical care. That, in turn, increases the opportunity of administering intravenous (IV) tissue plasminogen activator (tPA), the only FDA-approved medication to treat acute stroke, which must be used four-and-a-half hours after symptoms start. Some patients also require endovascular therapy, a procedure that removes blood clots using a thin catheter and other devices, such as stents, to restore blood flow to the brain. Early treatment with both IV tPA and endovascular therapy decreases the risk of disability in patients who would benefit from clot removal.
Everything that happens in the hospital can happen in this special ambulance, which is staffed with a nurse trained in stroke care, a technician proficient in computed tomography (CT) imaging, and a monitor screen connected to a neurologist, who can beam in remotely from almost anywhere via mobile technologies. After picking up the patient, the ambulance driver parks and levels the vehicle using special feet that emerge from below. While the neurologist examines the patient via video screen—asking him or her to smile, read cards, look left and right, and more—the nurse starts intravenous lines, assesses vitals, and draws blood. Once the CT technician is ready, the patient undergoes a CT scan, which is sent to a waiting radiologist, who interprets it and confers with the neurologist.
The patient is treated within minutes and transferred to a primary stroke center if symptoms are less serious, , or to a comprehensive stroke center, if the patient's symptoms are more severe, or if the patient needs endovascular treatment to remove larger blood clots.
Early evidence shows that mobile stroke units shorten treatment times in half, with the average patient being treated within 30 minutes. Given that patients are more likely to have a better outcome—to walk, return to work, and become more independent—if they receive IV tPA (and endovascular therapy), it is paramount that stroke centers find new and innovative ways to reach patients with stroke more quickly.
With every minute that passes, 1.9 million brain cells are destroyed during an acute stroke! Although expensive—a mobile unit costs just under $1 million plus another $1 million to operate—it's worth it if it helps save more of those precious minutes.
For more about mobile stroke units and stroke care, go to bit.ly/NN-Telemedicine.
Dr. Sarah Song is an assistant professor of neurology at Rush University Medical Center in Chicago, IL, and a member of Neurology Now's editorial advisory board.