The goal of the Mobile Stroke Unit is to shorten the time between the onset of stroke-like symptoms and the delivery of “clot-busting” – or thrombolytic – drugs, which must be administered within three hours of when symptoms began or when the patient was last known to be well.
How it Works
The unit resembles an ambulance on the outside, but inside it contains highly specialized staff, equipment and medications strictly used for diagnosing and treating strokes. It is equipped with a portable CT scanner that is capable of imaging the patient’s brain to detect the type of stroke they are experiencing. The CT scans are wirelessly transmitted to Cleveland Clinic neuroradiologists, who deciphers if the patient is experiencing a stroke, and if so, whether the stroke is ischemic (caused by a blood clot) or hemorrhagic (caused by a ruptured blood vessel). Meanwhile, stroke neurologists access the patient’s symptoms via telemedicine technology while en route to the hospital.
A mobile lab is able to test blood samples on board. If it is found that the patient is experiencing an ischemic stroke – which account for about 87 percent of all strokes – the on-board medical team can initiate intravenous (IV) tissue plasminogen activator (tPA) to attempt to break up the clot.
“Despite the fact that tPA has been FDA approved to treat stroke patients for almost 20 years, it is still underutilized. Even across our Cleveland Clinic Health System, which includes one Comprehensive Stroke Centers, eight Primary Stroke Centers and Stroke Ready Centers, only 15 percent of patients arrive within the three-hour time window for intravenous tPA, making delay in presentation the most common reason patients were ineligible for this life-saving treatment,” says Peter Rasmussen, M.D., Director of Cleveland Clinic’s Cerebrovascular Center. “We care for more than 3,000 stroke patients on an in-patient basis each year, and if we can reach these patients faster by going directly to them and administering the medication on scene, we have the potential to offer stroke patients better short-term and long-term outcomes.”
TPA, which was approved by the FDA in 1996, dissolves blood clots and works best when given right away. It increases recovery from stroke symptoms by up to 50 percent and has a low serious complication rate. On a national scale, only 3 to 8.5 percent of potentially eligible patients receive tPA, according to a study in JAMA. Ideally, more than 40 percent of all stroke patients should receive it. According to the Centers for Disease Control, stroke is the fourth leading cause of death and a leading cause of serious, long-term disability in the U.S.
The Mobile Stroke Unit, which is comprised of a paramedic, a critical care nurse, a CT technologist and an EMS driver, is integrated into the 9-1-1 dispatch system in the city of Cleveland. If the 9-1-1 dispatcher believes after asking a series of questions that a patient is experiencing stroke-like symptoms, crews from both Cleveland EMS and Cleveland Clinic’s Mobile Stroke Unit will be dispatched to the scene. Upon receiving the treatment, the patient will be transported to the closest Primary Stroke Center. The unit will be housed at Cleveland Clinic’s main campus in Cleveland. Cleveland Clinic Critical Care Transport employees will also be cross-trained to be able to work on the new unit.
“We see this unit as an important tool in our emergency response toolkit. If a patient is experiencing a stroke and the unit is on the scene with us, this allows our Cleveland EMS squads to return to service and be available to take another call while the stroke unit treats and transports the patient,” said Nicole Carlton, Emergency Medical Services (EMS) Commissioner for the City of Cleveland. “This unit is truly an innovative way for us to diagnose and treat stroke patients faster, and it is one more way the medical community is working together to improve emergency response and care for patients.”
The novel approach to treating patients faster on the scene is made possible with the support from the Maltz Family Foundation of the Jewish Federation of Cleveland. The $1 million gift will support the Mobile Stroke Unit in Cleveland and research to study how the unit affects patient outcomes.
Established by Milton and Tamar Maltz, the Maltz Family Foundation of the Jewish Federation of Cleveland has generously supported numerous local and national philanthropic and civic organizations that includes the Maltz Museum of Jewish Heritage, The Cleveland Orchestra, the Cleveland Museum of Art, the Maltz Performing Arts Center at Temple-Tifereth Israel, the Lieber Institute for Brain Development, and the Maltz Jupiter Theatre. Mr. Maltz, a national broadcast pioneer, founded Malrite Communications Group in 1956 and served as its chairman and CEO until the company was sold in 1998.
“The Cleveland Clinic never stops in its quest to better serve mankind. How fortunate we are to live here in Cleveland in the very heart of medical breakthroughs,” Mr. Maltz said. “Tamar and I are pleased to have helped the Clinic set the standard for outstanding medical practice.”
The Cleveland Clinic team behind the mobile stroke treatment unit visited one of the first units of its kind in Berlin, Germany, to learn more about their experience with it. Recently, the Berlin team reported in the Journal of the American Medical Association that “ambulance-based thrombolysis resulted in decreased time to treatment without an increase in adverse events.” In addition, the Berlin unit reduced ambulance-arrival-to-drug time by 36 minutes and increased IV tPA utilization rate to 50 percent in acute ischemic stroke patients.
How to Utilize the Mobile Stroke Unit
“The key takeaway we want Clevelanders to know is to call 9-1-1 if they or a loved one is experiencing stroke-like symptoms, and the dispatchers will take it from there,” said Dr. Rasmussen. “Time is truly of the essence when it comes to stroke care, so the sooner a patient gets treatment, the higher likelihood they will be able to receive the clot-busting treatment that could help them recover more fully and live their lives without long-term disability.”
It is important to know the symptoms of a stroke. Warning signs include sudden loss of speech, sudden loss of vision, weakness, dizziness or a severe headache, among many others. It is crucial to call 9-1-1 and get to a hospital immediately.
- MedCity News, 8/5/14