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Bringing an ER to Stroke Patients

Mobile units can get help to people when every minute counts

Mobile stroke unit

Courtesy of Frazer Bilt

MICHAEL SMITH, now 73, was spreading peanut butter on an English muffin one morning last January when, he says, “suddenly I couldn’t let go of the knife and my mouth sort of hung open.” Recognizing that he was having a stroke, his wife, Mary, called 911. As emergency medical technicians rolled Smith out of his Phoenix condo on a stretcher, the Barrow Neurological Institute’s mobile stroke unit rolled into the condo’s parking lot.

Smith, a retired architect, describes being wheeled into “a miniature emergency room” right there, outside his building. “The stroke team checked my vitals, did a CT scan of my brain, conferred with a neurologist and administered a clot-busting drug, all in less than an hour. Their fast action is the reason I’ve recovered so well.”             

During a stroke, treatment access time is essential: 1.9 million neurons and 7.5 miles of nerve fibers in the brain die during every minute of a stroke. “Getting treatment within an hour can be the difference between resuming your life at 90 percent or better capacity, and being bedridden and dependent on other people for the rest of your life,” explains neurologist Michael Waters, director of Barrow’s Stroke Program. But, he adds, it’s critical to diagnose the cause as fast as possible, because administering the wrong treatment could be fatal.

That’s why hospitals are taking the ER to the stroke victim. Ten U.S. cities have mobile stroke units. But the price tag for these big ambulances is $1 million, plus an estimated $1 million in annual operating costs, sparking a national debate about whether the results are worth the cost. A nationwide study is expected to provide an answer in a few years. “Compare it with the long-term cost of a devastating stroke, in terms of treatment, long-term care, rehab and lost wages in someone’s peak years of productivity in their 30s, 40s, 50s or 60s, and I think mobile stroke units will prove their worth,” Waters says. Smith agrees: “I’m a big fan,” he notes. “You’d have to work pretty hard to convince me they’re not worth the money.”


Q: What is the most exciting development in stroke treatment?

A: With ischemic stroke, new imaging software allows us to more precisely define the area of stroke damage around a blocked blood vessel in the brain and the area of salvageable brain tissue. This lets us effectively treat more patients without knowing exactly when their symptoms arose — even to treat patients who have a stroke while sleeping.

— MICHAEL WATERS, neurologist and director of the Barrow Neurological Institute Stroke Program in Phoenix

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