Abstract TP263: Mobile Stroke Unit Operation in a Topographically Variable County

Abstract

Introduction: Mobile Stroke Units (MSUs) require a level surface for CT scanner operation. The MSU is equipped with a user-friendly leveling system which can compensate for a front-to-back maximum angle of 3.8° or a 6.6% grade, and a left-to-right maximum angle of 10.4° or an 18.4% grade, but this still requires the unit be parked on a relatively flat location. Previous reports of MSU operations have been from topographically flat and fairly uniform communities. In San Mateo County, many neighborhoods are topographically variable which makes access challenging. This study describes process improvements made to ensure successful and efficient treatment of stroke patients on the MSU in this environment. Methods: A workflow change was instituted to adapt to locations which the MSU either could not directly access due to size, or at which the grade was clearly greater than could be accommodated for using the internal leveling system. For particularly hilly areas, pre-specified “staging” locations were identified. These locations met the following criteria: flat grade, adequate space for the MSU, requiring minimal additional driving time en-route to destination hospital. The locations were scouted with the assistance of local EMS and Fire Departments. The MSU team evaluates the patient at the original location, and takes the patient onboard the MSU if the patient meets criteria for transport. Then, the MSU drives with the patient to the pre-specified “staging” location, where the CT scan is performed and rt-PA treatment decision is made. Results: Employing this process improvement has eliminated additional on-scene time spent looking for a more level location. Clear algorithms, when challenging locations are encountered, allow for smooth workflow and limit delays to treatment. Additionally, in hilly areas, cellular service is often unreliable, so traveling to a “staging” location has often improved connectivity for telemedicine. Conclusion: This study is the first to describe a standardized workflow solution to challenging topography. As MSUs become more prevalent, reproduction of this process improvement may prove useful to other counties facing similar challenges, while improved leveling capabilities are being concurrently developed.