Bringing the Emergency Department to the Patient
TOM DOOR: There's nothing more important in life than time.
People that talk about, their bored, or the days
are too long, they're wrong.
Every minute is precious.
A few years ago, in my early 60s, I was at home.
And I was not feeling particularly good.
I was a little bit dizzy.
I lost my balance and I couldn't walk.
My girlfriend, she went to one of the neighbors.
There's a husband and a wife, they're both paramedics.
And I had a stroke.
They called 911 immediately.
And I was taken to Mills-Peninsula Medical Center.
They did a brain scan and administered
tPA, a blood thinner.
And then, subsequently, I was taken
to California Pacific Medical Center in San Francisco.
I was extremely fortunate.
I refer to it as the perfect storm.
A lot of things could have gone wrong but they didn't.
JOEY ENGLISH: Time is everything when you're
treating the stroke patient.
When the patient arrives to the emergency room,
we are trying to go as fast as possible.
Stroke happens when there is a disruption of the blood
supply to an area of the brain.
About 85% of the time, strokes are
caused by a blockage of a blood vessel.
About two million nerve cells die per minute,
when you have a blockage of a blood vessel.
It is extremely time sensitive.
Even a 15 to 30 minute delay in delivering a clot dissolving
medication can dramatically impact the likelihood
that patient's going to recover well from their stroke.
Tom was very lucky with his stroke.
His care happened very quickly and efficiently.
The truth is most people don't receive that type of care.
And that is why we came up with the concept of the Mobile
Stroke Unit.
NOBL BARAZANGI: The current way that we
treat stroke patients is that 911 is called,
or family or friends bring the patient into the emergency
room.
But there is this inherent delay of getting the patient
to the emergency room.
The goal of the Mobile Stroke Unit
is to provide faster and safer care.
JOEY ENGLISH: The Mobile Stroke Unit
is a specialized ambulance that has within it, a CT scanner.
And in addition to that, it carries the expertise
of a nurse and a physician who know how to evaluate and treat
stroke.
NOBL BARAZANGI: It brings the emergency room to the patient,
to wherever the stroke patient is having their stroke.
And so we're saving time by getting
the CAT scan in the field so that treatment
can be initiated faster.
JOEY ENGLISH: The Mobile Stroke Unit
is based at Sutter Health's Mills-Peninsula Medical Center,
and will be dispatched throughout San Mateo
County integrated with the San Mateo County first responders
and the 911 response team.
GREGORY GILBERT: By being one of the first mobile stroke
units in the country, we'll be on the forefront
of knowing whether or not this new technology is
the way that we should be taking care of patients.
JOEY ENGLISH: Everything fell into place for Tom.
That is how we want all of our stroke patients to be treated.
We think the Mobile Stroke Unit can have a dramatic impact
on stroke in this country.
TOM DOOR: If this Mobile Stroke Unit
can save lives and continue to keep people
in a meaningful way in the community
and with their families, there's going
to be a lot of people getting another chance, getting
more time.
This is going to be the future.
I got a big do-over.
And I'm making every minute count.
[MUSIC PLAYING]
Mills-Peninsula's Mobile Stroke Unit was one of the first hospitals in the West Coast joining Houston, Denver, New York, Chicago, Cleveland and Los Angeles to pilot this technology. Preliminary studies have indicated that a mobile stroke unit can reduce the time from ambulance dispatch to treatment to as little as 11 minutes. Data gathered through the Mills-Peninsula pilot will contribute to national efforts aimed at demonstrating the Mobile Stroke Unit’s ability to:
- Reduce stroke-related disability and mortality
- Reduce the need for post-stroke rehabilitation and hospitalization
The Critical CT Scan
There are two types of stroke — ischemic and hemorrhagic. Ischemic strokes are blockages while hemorrhagic strokes bleed. While about 85 percent of strokes are ischemic and need the blockage removed as quickly as possible, the medication given to dissolve the clot — known as tissue plasminogen activator (tPA) — could be fatal if given to a hemorrhagic stroke patient.
If the CT scan shows a hemorrhagic stroke, the patient can be transported to the nearest hospital where a stroke team is ready to jump into action based on the diagnosis.
“You can’t make any decision until you diagnose what type of stroke the patient has,” Joey English, M.D., Ph.D. MSU co-principal investigator says. “And every minute faster we treat the patient saves an estimated 2 million brain cells.”
“The point of the research study is to see if having a Mobile Stroke Unit benefits the community,” Jenny Im, R.N., director of the Neuroscience Service Line says. “Do patients have better, long-term outcomes and is the cost to the overall care system lower if we can shorten the time from onset of symptoms to tPA?”