Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May 17:9:283.
doi: 10.3389/fneur.2018.00283. eCollection 2018.

World's First 24/7 Mobile Stroke Unit: Initial 6-Month Experience at Mercy Health in Toledo, Ohio

Eugene Lin  1 , Victoria Calderon  1 , Julie Goins-Whitmore  1 , Vibhav Bansal  2 , Osama Zaidat  1
Affiliations

World's First 24/7 Mobile Stroke Unit: Initial 6-Month Experience at Mercy Health in Toledo, Ohio

Eugene Lin et al. Front Neurol. .

Abstract

Background and purpose: As the fourth mobile stroke unit (MSU) in the nation, and the first 24/7 unit worldwide, we review our initial experience with the Mercy Health MSU and institutional protocols implemented to facilitate rapid treatment of acute stroke patients and field triage for patients suffering other time-sensitive, acute neurologic emergencies in Lucas County, Ohio, and the greater Toledo metropolitan area.

Methods: Data was prospectively collected for all patients transported and treated by the MSU during the first 6 months of service. Data was abstracted from documentation of on-scene emergency medical services (EMS) personnel, critical care nurses, and onboard physicians, who participated through telemedicine.

Results: The MSU was dispatched 248 times and transported 105 patients after on-scene examination with imaging. Intravenous (IV) tissue plasminogen activator (tPA) was administered to 10 patients; 8 patients underwent successful endovascular therapy after a large vessel occlusion was identified using CT performed within the MSU without post treatment symptomatic hemorrhage. Moreover, 14 patients were treated with IV anti-epileptics for status epilepticus, and 19 patients received IV anti-hypertensive agents for malignant hypertension. MSU alarm to on-scene times and treatment times were 34.7 min (25-49) and 50.6 min (44.4-56.8), respectively.

Conclusion: The world's first 24/7 MSU has been successfully implemented with IV-tPA administration rates and times comparable to other MSUs nation-wide, while demonstrating rapid triage and treatment in the field for neurologic emergencies, including status epilepticus. With the rising number of MSUs worldwide, further data will drive standardized protocols that can be adopted nationwide by EMS.

Keywords: ambulances; cerebrovascular disease/stroke; mobile stroke unit; telemedicine/telestroke; thrombolysis; tissue plasminogen activator.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) Mercy Health Mobile Stroke Unit (MSU) workflow and triage algorithm from activation. (B) Mercy Health MSU activation and triage algorithm part 2.
Figure 1
Figure 1
(A) Mercy Health Mobile Stroke Unit (MSU) workflow and triage algorithm from activation. (B) Mercy Health MSU activation and triage algorithm part 2.
Figure 2
Figure 2
(A) First 6 months trend of average decision to scan time. (B) First 10 Mobile Stroke Unit (MSU) tPA patients from on-scene arrival to tPA administration.
Figure 3
Figure 3
(A) Comparison of Mercy Health Mobile Stroke Unit (MSU) to ED patients demonstrating the difference in minutes of patient triage and stroke metrics. (B) Comparison of Mercy Health MSU to ED with percent of patients treated in the golden hour under 60 min and percent treated of those activated for stroke evaluation.
See this image and copyright information in PMC

References

    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics – 2015 update: a report from the American Heart Association. Circulation (2015) 131(4):e29–322.10.1161/CIR.0000000000000157 - DOI - PubMed
    1. Pérez de la Ossa N, Carrera D, Gorchs M, Querol M, Millán M, Gomis M, et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion. rapid arterial occlusion evaluation scale. Stroke (2014) 45(1):87–91.10.1161/STROKEAHA.113.003071 - DOI - PubMed
    1. Bowry R, Parker S, Rajan SS, Yamal JM, Wu TC, Richardson L, et al. Benefits of stroke treatment using a mobile stroke unit compared with standard management: the BEST-MSU study run-in phase. Stroke (2015) 46(12):3370–4.10.1161/STROKEAHA.115.011093 - DOI - PubMed
    1. Walter S, Kostopoulos P, Haass A, Keller I, Lesmeister M, Schlechtriemen T, et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol (2012) 11(5):397–404.10.1016/S1474-4422(12)70057-1 - DOI - PubMed
    1. Wendt M, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, Weber JE, et al. Improved prehospital triage of patients with stroke in a specialized stroke ambulance: results of the pre-hospital acute neurological therapy and optimization of medical care in stroke study. Stroke (2015) 46(3):740–5.10.1161/STROKEAHA.114.008159 - DOI - PubMed