Mobile stroke units and urgent decision making

Abstract

Improving systems of care to deliver acute stroke therapies faster is one of the best ways to optimize patient outcomes. Every minute saved in the time between stroke onset and restoration of cerebral blood flow reduces disability. This talk will discuss a range of interventions to reduce treatment delays in the pre-hospital and emergency department setting. Mobile Stroke Units (ambulances equipped with specialized stroke clinicians and a CT scanner) are one potential tool to reduce the time from stroke onset to treatment initiation. Mobile stroke units can also definitively differentiate intracerebral hemorrhage from large vessel occlusion ischemic stroke and non-large vessel occlusion ischemic stroke and therefore determine the optimal hospital destination for the individual patient. Bypassing a patient with large vessel occlusion directly to an endovascular-capable hospital dramatically reduces the delay to treatment, often by 1-2 hours, and this directly translates into reduced patient disability. For non-large vessel ischemic stroke a mobile stroke unit can initiate thrombolysis considerably earlier than in the emergency department, again potentially reducing disability. Even without a mobile stroke unit, paramedic clinical assessment using severity-based triage scores and algorithms can improve the proportion of patients transported direct to an endovascular-capable hospital. Pre-notification of the receiving hospital allows activation of the stroke team and transport direct to the CT scanner on the ambulance stretcher reduces in-hospital door to needle time.