EMS World

AUG 2016

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28 AUGUST 2016 | EMSWORLD.com For Osaka it saved both: She received treatment about 78 minutes after symptom onset, faster than 99% of stroke patients. And within days she was moving her affected left side, speaking clearly and walking on her own. "In just one day," Osaka told media reps from the University of Texas Health Science Center at Houston (UTHealth), which fields the unit, "I went from not being able to speak to speaking but no one could understand me to now speaking and pronouncing things perfectly. Before the end of that same day, I could also move my hand again. It was like a dream! I could even stand up and walk!" 1 A Broad Range of Solutions Mobile stroke units began in Germany almost a decade ago but have only recently come to the U.S. UTHealth's was first (see page 33), but others have quickly fol- lowed. The Cleveland Clinic rolled its out soon after in 2014. More started the next year in Toledo and Colorado. Another that debuted this year in Memphis raises the bar with a hospital-grade Siemens SOMATOM Scope scanner and CT angiography imaging of the brain and blood vessels. These things aren't cheap, and that systems are investing in them underscores the difficulty we've had helping stroke victims in the timely way they need. To that end, mobile stroke units could represent a big advance. "Historically strokes have had to be identified in the field and brought to the hospital for a CAT scan," says Andrei Alexandrov, MD, chair of the neurology department at the Uni- versity of Tennessee Health Science Center and medical director for the Memphis project. "Only recently have the CAT scanners become mobile. So placing one on the ambulance essentially allows the door-to-needle time to become the time from the field to the door of the ambulance. This can shorten the time from symptom onset to treatment and in turn result in more patients recovering from stroke. It's a very exciting opportunity." Indeed it is—the cost of strokes is terrible. They're the fourth- leading cause of death in the U.S., and a top cause of disability. Around 800,000 Americans a year have them, to a price tag of about $38 billion. The ischemic variety accounts for 87%, and while ischemic strokes are quite treatable with tPA, that needs to happen within a limited time window. All kind of obstacles work against that, from delays in recognition and calling 9-1-1 to prolonged scene and ED times and times to getting patients scanned and treated. Mainly because of such delays, just 3%–8.5% of American patients who are eligible for tPA get it. More than 40% should. 2 So anything we can do to get it to them faster should benefit them—right? That would seem to be the case with mobile stroke units (MSUs). Because they're so new, there's not yet a huge volume of data amassed, but what there is has been positive: » A 2014 JAMA writeup of the German PHANTOM-S study reported alarm-to-treatment times averaged 15 minutes faster during weeks when a stroke vehicle (STEMO) was available, and patients for whom it was deployed had a mean alarm-to-treatment time 25 minutes shorter than during control weeks. Thrombolysis rates were 21% during control weeks, 29% during STEMO weeks and 33% after STEMO deployment. 3 » A 2012 Lancet report found that prehospital stroke treat- ment reduced the median alarm-to-therapy-decision time from 76 minutes to 35. A team led by Silke Walter, MD, of Germany's University Hospital of the Saarland discovered similar gains in intervals from alarm to CT completion, alarm to end of labora- tory analysis, and to the overall rate of IV thrombolysis for eligible ischemic stroke patients. 4 » A preliminary 2010 piece by most of the same authors used case studies to show the "feasibility of guideline-adherent, etiology- specific and causal treatment of acute stroke directly at the emer- gency site." One of those patients had a hemorrhagic stroke; she received guideline-based differential blood pressure management. Both patients had call-to-therapy-decision times of approximately 35 minutes and good outcomes. The cases, Walter and company concluded then, "illustrate the broad range of medical solutions made available by use of the MSU. The MSU…encompasses all major aspects of prehospital stroke medicine, such as prehospital organization of bridging to For More Information Circle 42 on Reader Service Card 888-458-6546 3121 Millers Lane Louisville, KY 40216 Tel: 502-775-8303 Fax: 502-772-0548 S A F E T Y A P P L I A N C E C O M P A N Y www.junkinsafety.com PROUDLY MANUFAC TURED IN THE USA JSA-400 Aluminum Break-Apart Stretcher Specifications Dimensions: 66 ¼" L x 17 ½" W x 2 5⁄8" H Folded Length: 49 ½" Folded Depth: 3 ½" Adjustable to: 80" Load Capacity: 400 lbs. Shipping Weight: 21 ½ lbs. Designed to gently maneuver stretcher under patient without rolling or lifting. The center of the Junkin Aluminum Break-Apart Stretcher can be opened to allow the patient to be X-rayed while secured on the stretcher. Features sturdy, lightweight aluminum construction with an adjustable length and three patient restraint straps. Folds for easy storing and separates in half during application and removal. 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