CHICAGO – Residents of Broadview, Illinois, who report symptoms of stroke can now receive state-of-the-art, emergency stroke care at their own homes.
The Rush Mobile Stroke Unit will be able to go directly to a potential stroke patient's home in the Broadview community to begin treatment. The unit is a custom-built, state-of-the-art ambulance outfitted with telemedicine technology, brain imaging technology and drug therapies that are critical to accurately diagnose and immediately begin treatment for stroke.
The Mobile Stroke Unit is based at Rush Oak Park Hospital, about 10 miles west of downtown Chicago. Within 15 minutes driving time from Rush Oak Park Hospital are 330,000 suburban residents, 883 of whom actually experienced strokes during 2015. Rush is working to arrange to provide Mobile Stroke Unit care in more of these communities in the near future.
Mobile stroke units are a new concept in the U.S., and there are only six in service nationwide. In October 2016, Rush became the first hospital in Illinois to announce plans to develop a mobile stroke unit.
Quick treatment can mean difference between life and death
“Receiving the correct treatment for stroke quickly can mean the difference between life and death or disability, but it in most cases treatment must be provided to patients shortly after a stroke to be effective,” said Dr. James Conners, medical director of the Rush Comprehensive Stroke Center and the Rush Mobile Stroke Unit. “Presently, patients cannot be treated for their stroke until they get to an emergency department. 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.”
“We’re talking about having the ability to check patients in their own driveways for bleeding in the brain or blockage in their blood vessels,” says Demetrius Lopes, MD, surgical director of the Rush Comprehensive Stroke Center. “This ability is crucial, since stroke treatment decisions depend on CT scan imaging of the brain.”
Goal is optimal treatment in the ‘golden hour’ after stroke symptoms begin
The mobile stroke team will respond to 911 calls reporting symptoms indicating stroke and can perform CT scans of patients promptly upon arrival. Rush radiologists will receive and analyze transmissions of these detailed brain images from the unit to determine whether a patient has experienced a stroke, and if so, which type of stroke it is. Rush stroke neurologists will evaluate the patients remotely and decide what kind of treatment is indicated.
Critical care registered nurses staffing the mobile unit will administer the appropriate stroke medication after conferring with the stroke neurologist and then transport 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.
"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,” Conners said.
“With the support of Mayor Katrina Thompson, the Village of Broadview and the Broadview Fire Department are excited to partner with Rush University Medical Center's new Mobile Stroke Unit,” said Tracy Kenny, chief of the Broadview Fire Department. “This is an exciting advancement in health care that provides our residents with definitive, immediate care in the 911 setting.”
“Our paramedics are trained to the highest level and are able to see the need for the Mobile Stroke Unit's intervention, when a patient is experiencing signs of a stroke. Our ability to get initial information, vitals, and do the much needed ALS interventions, prior to their arrival, prepares the patient for advanced technology that comes to the scene, increasing the chances of survival and/or recovery,” Kenny said.
Few stroke patients receive treatment in time to get clot-busting drug
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. This "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 says. “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.”
Unit will help identify and transport patients needing clot removal procedure
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,” Lopes 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,” Lopes 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,” Lopes continues. “This information is essential to determine the level of care the patient needs.”
Mobile stroke units can provide treatment within 30 minutes
The Mobile Stroke Unit enhances 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,” Lopes 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 performance of other mobile stroke units in the United States has shown that the time from onset of symptoms to treatment can be shortened in half, with the average patient being treated within 30 minutes of calling 911.