VOL. 10 | NO. 1 | Saturday, December 31, 2016
UT Mobile Stroke Unit Saving Lives in First Months on Streets
By Michael Waddell
With just more than four months on Memphis streets since its debut, the College of Medicine at the University of Tennessee Health Science Center is already seeing impressive results from its new Mobile Stroke Unit.
The unit is capable of conducting and producing advanced quality imaging for stroke diagnosis and noninvasive CT-angiography.
View inside the Mobile Stroke Unit being operated by the University of Tennessee Health Science Center's College of Medicine.
“Right from the very first day, it was clear that we really having a winning technology,” said Dr. Andrei V. Alexandrov, UTHSC chairman of the Department of Neurology and Semmes-Murphey professor.
“As soon as we arrive, we do things on the ambulance the same way as any good emergency room,” Alexandrov said. “We are able to evaluate the patient with experts in stroke care and perform CT scans in record time.”
Stroke is the fifth leading cause of death in the U.S., according to the American Stroke Association, killing someone every four minutes. African Americans have nearly twice the risk of a first-ever stroke and a much higher death rate from stroke. Stroke is also the leading cause of disability in the country.
The concept of the mobile stroke unit was pioneered in the U.S. by Alexandrov’s mentor, Dr. James Grotta, at the University of Texas Health Science Center at Houston in 2014.
“As soon as we saw that it was feasible, we also decided that the Memphis area would be ideal for such an ambulance because of favorable geography and traffic conditions, with Memphis being not as congested as some major cities,” Alexandrov said.
People in Shelby County suffer strokes 37 percent more often than the national average.
The ambulance features a state-of-the-art CT scanner just like the ones used in hospitals, making it the first of its kind in the country. Previous units featured portal CT scanners that provide a more limited view of the brain. The scanners allow medical personnel to determine whether there is bleeding to the brain, assess the type of stroke, and then they can decide on the best hospital that can provide the best treatment.
Strokes can be recognized by facial drooping, garbled or slurred speech, or paralyzation on one side of body. Response time is critical, and acting quickly can impact the quality of life one will have after having stroke.
“Time is brain, and so every second counts,” Alexandrov said. “We’re able already to cover at least 75 percent of the population of Memphis from a single fire station location.”
People born in the Southeastern U.S., also known as the Stroke Belt, are twice more likely to experience strokes in their lifetime compared to people born elsewhere in the country. Family history and diet are key factors in an individual’s likelihood of having strokes, with high blood pressure and blood sugar along with a lack of exercise as contributors.
The mobile stroke unit can have a definitive diagnosis just seven minutes after it arrives on the scene, and it can be administering treatments like tissue plasminogen activator (tPA) and the potent blood pressure drug nicardipine within eight minutes.
In comparison, the expected metrics for a hospital for time from patient arrival to completion of CT scan is 25 minutes and to administer tPA it can be more than an hour. Those extra minutes saved translate to brain cells and lives saved for stroke victims.
“We can do everything that primary level stroke center can do in emergency rooms the hospital,” said Joe Rike, director of the mobile stroke unit and former EMT. “And with the advanced technologies that we have on this mobile stroke unit, when the patient has a large vessel occlusion they will go to the cath lab where the neurosurgeons would actually go up and extract the clot after the tPA is given.”
Rike touts the fact that one patient a few weeks ago was in the cath lab just 15 minutes from the time the mobile stroke unit arrived on the scene.
The sophistication of the UT College of Medicine Mobile Stroke Unit means a patient will be prepped to go straight to the catheterization laboratory, Neuro Intensive Care Unit or Hospital Stroke Unit, bypassing the stop in the emergency department entirely.
The unit is parked at the Engine 14 firehouse in the Stax neighborhood, which was identified as an area of extreme need. Off-duty fire paramedics and advanced EMT’s were hired to help man the unit.
In the first four months, they have responded to 187 calls and transported 91 patients (17 received tPA to treat blood clotting in the brain).
“Once we get on the scene, the determination to scan is made by the nurse practitioner or the doctor on the mobile unit,” Rike said.
The ambulance operates 12 hours a day, alternating one week on and one week off for data comparison purposes, and it is dispatched on average about four times per day. UTHSC will collect data for at least three years and will compare data with a consortium of institutions in other cities.
Mobile stroke units also operate in Denver, Chicago, Phoenix, New York City and Toledo, Ohio, and Los Angeles will have one soon.
“Patients are receiving better and quicker treatment when we’re in service than they are when we’re out of service,” said Rike, who is confident the service will become full time before long.