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

Abstract

Background and purposeAs 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.MethodsData 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.ResultsThe 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.ConclusionThe 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.

Improving Prehospital Stroke Services in Rural and Underserved Settings With Mobile Stroke Units

“…MSUs have been shown to play an integral role in evolving stroke services. They have been demonstrated to be effective in improving key prehospital temporal metrics (such as alarm-to-therapy and alarm-to-imaging times) in many centers worldwide (19, 25, 28, 29, 34, 42, 43). However, there remain relevant stroke treatment gaps for rural patients.…”

Googling Location for Operating Base of Mobile Stroke Unit in Metropolitan Sydney

“…It is possible that the issue of deciding between thrombolysis and ECR capable hospitals and MSU in a well-service catchment has not been explored in detail, as some of the centers operating MSU have only one ECR hub and have a small catchment population. Sites such as Lucas County serves a population of 433,689 (33); New Jersey model serves a modest population of 460,000 (34); and the Cleveland model serves a population of 390,000 (35). In Germany, there is exploration on the deployment of MSU in rural areas (16).…”

“…The running cost of operating MSU during office hour is estimated to be around US$1,000,000 (34). Recently, a group in Lucas County Ohio reported on their initial experience with operating MSU 24 h a day (33). Data on 24-h operation and cost effectiveness study such as these will help inform the need for MSU.…”

Advances in pre-hospital care - operational experiences from the Melbourne mobile stroke unit

“…The largest reported cohort from the Berlin MSU initially reported increase in golden hour thrombolysis from 5% to 31% [9] , but more recent updates show the figure at 13% [11] and much closer to the Melbourne service. Three US-based MSUs also reported golden hour thrombolysis between 27%-33% [12][13][14] but all with very small patient numbers (< 20). The proportion of non-MSU patients receiving golden hour thrombolysis in-hospital was reported as 1.3% in a very large US treatment cohort (n = 65,384 patients) [15] , which is also very close to that of metropolitan Melbourne.…”