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Doctors to Treat Suspected Stroke Cases at Patients' Homes

(CHICAGO) – Rush University Medical Center unveiled a unique mobile stroke treatment unit — a specially built, state-of-the-art ambulance outfitted with telemedicine technology and a CT scanner enabling brain imaging that is critical to accurate stroke diagnoses and treatment.

The event was at Rush Oak Park Hospital, where the mobile stroke treatment unit will be based. One of only a handful of specially designed and built units of its kind in the United States, it will serve Illinois Region VII, which includes parts of the western suburbs. 

The unit was brought in for a presentation by Rush stroke team members for area fire chiefs and emergency management services officials from 10 suburban Chicago municipalities. They will work with Rush to develop protocols around emergency dispatch.

The mobile stroke unit brought to Rush Oak Park Hospital by the manufacturer, Excellence, is identical to one still being outfitted for Rush. It will be delivered in January.

Receiving the correct treatment for stroke quickly is based on accurate diagnosis of the stroke with a rapid neurologic assessment and CT scan. Faster diagnosis and subsequent treatment can mean the difference between life and death. In most cases, treatment must be provided to patients shortly after a stroke to be effective.

“Presently patients cannot be treated for their stroke until they get to an emergency room. 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,” said James Conners, MD, MS, medical director of the Mobile Stroke Unit.

“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,” says Conners. “This ability is crucial, since stroke treatment decisions depend on CT imaging of the brain.”

The mobile stroke treatment team will respond to 911 calls reporting symptoms indicating stroke along with a regular ambulance. If the paramedics determine the person did not have a stroke but has another medical problem, the Mobile Stroke Unit will simply return to their base station. If stroke is suspected, the team can perform CT scans of patients and using telemedicine, Rush stroke neurologists will evaluate the patients remotely and decide what kind of treatment is indicated. The emergency medical technician and critical care nurse staffing the mobile unit will administer the appropriate stroke medication after conferring with the stroke neurologist at the same time they are transporting the patient to the most appropriate stroke center.

The goal is to provide optimal treatment to stroke victims within the first "golden hour" after symptom onset, when it will do the most good.

A stroke occurs when blood flow to the brain stops, causing brain cells to stop receiving oxygen. Stroke is the number one cause of disability and the fifth leading cause of death in the United States. On average, someone has a stroke every 40 seconds. About 87 percent of all strokes are ischemic — that is, strokes that are caused by a clot that blocks a blood vessel carrying blood to the brain, cutting off the brain’s supply of oxygen and causing brain tissue to die. The standard treatment of such strokes is a drug called tissue plasminogen activator, or tPA, which can dissolve clots and restore blood flow in the brain. The "clot-buster" drug can restore blood flow, preventing death and minimizing disability.

Studies have shown, however, that tPA works best if administered within 90 minutes of the stroke occurrence and that it is ineffective after 4.5 hours. At that point, after "the damage is done," the drug is simply not used, Conners says. Because of this narrow treatment window — combined with various delays in stroke patients receiving care — only a small number of patients in this country who have ischemic strokes, no more than about 5 percent, are treated with tPA.

"We know patients are up to four 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,” Conners explains. “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.”

Getting patients to the right places for the right care Sometimes tPA alone may not be sufficient treatment even when provided in time.

“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,” Conners says.

Neuroendovascular surgeons at these centers can perform an advanced, minimally invasive procedure called thrombectomy to go into the brain via arteries and veins to remove the blockage causing the stroke. Only comprehensive stroke centers offer this procedure, and Rush is one of only six such centers in the Chicago area certified by the Joint Commission (the leading health care accrediting organization).

“If you’re not assessing patients in the field, you’re missing an opportunity,” Conners says. “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.

“The CT in the Mobile Stroke Unit will allow us not only to obtain brain but also blood vessel pictures,” Conners continues. “This information is essential to determine the level of care the patient needs.”

The Mobile Stroke Unit also will enhance treatment for patients who suffer from a hemorrhagic stroke, which occurs when a blood vessel in the brain leaks or bursts. Those patients can’t receive tPA, which could be fatal to them, and need a different type of medication to stop their bleeding.

“With the CT scan, the mobile stroke team can separate the bleeding strokes in the brain from the blockage strokes,” Conners says. “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 hope is that the new program will capture 75 percent of strokes in the service area in time to deliver optimal treatment for all stroke patients.

A second aspect of the Rush program is community outreach and education in the region. It's important for people to be able to recognize stroke symptoms if they see them in friends, loved ones or themselves, and to understand the importance of calling a 911 dispatcher immediately. "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,” says Conners.

The performance of other mobile stroke units in the United States has shown that the time from onset of symptoms to treatment can be cut in half, with the average patient being treated within 30 minutes.

Contact:

Deb Song
(312) 942-0588
deb_song@rush.edu

 

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