EMS World

AUG 2016

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32 AUGUST 2016 | EMSWORLD.com "Roughly what we've found," says Ras- mussen, "is that almost any aspect of care that's delivered in an emergency room in our healthcare system is delivered equally as good if not better on the mobile stroke unit." CT Angiography In Memphis stroke incidence beats the national average by 37%. Its MSU is the first in the southeastern "stroke belt" and billed as the most comprehensive in the world. That's largely due the CT angiography of which it's capable. The SOMATOM scanner has an automated gantry that moves the patient and provides as many slices (pic- tures) as can be obtained in the hospital. This allows visualization of blood vessels and the ability to identify patients who need endovascular interventions, neurosurgery and neurocritical care from the field. These capabilities make the Tennessee unit the mobile equivalent of the ER at any primary stroke center. "Imagine if you are able to both give IV tPA, as any primary stroke center does, and quickly identify the patient with emergent large-vessel occlusion," says Alexandrov. "Then you can bypass the nearest primary stroke center and go directly to the com- prehensive stroke center. And then bypass the emergency room and bring the patient directly to the cath lab. The CT angiog- raphy images can be sent directly to the endovascular suite, so the interventionist can see what kind of occlusion they will be dealing with when we bring the patient in." The Memphis truck was funded through a public-private collaboration that raised more than $3 million to run it for three years. Built by Medical Coaches, it will be based in the city's most stroke-heavy area but available throughout the metro region. When it came to staffing, UTHSC chose a middle ground between doc and box, using fellowship-trained, doctorally prepared nurses certified as advanced neurovascu- lar practitioners. "We wanted to explore the presence of a fellowship-trained nurse practitioner just because we want to understand all the nuances of the paramedics' work and how we can best integrate mobile technologies and treatment capabilities into it," says Alexandrov. "The United States has the advantage of several hospitals and stroke teams and cities that have fellowship- trained nurse practitioners." In anticipation of an eventual switch to teleneurology and teleradiology, proj- ect leaders plan to run connectivity tests throughout the city and make sure there are no dead spots. (Cleveland did the same to ensure broadband reliability.) The main goal of the Memphis project is to treat as many patients as possible in the first 60 minutes after symptom onset; leaders will also track 90-day functional outcomes. That's something they expect to interest the payers who will, if the MSU is successful, have to sustain it beyond its initial three years. "We are looking to address this issue with Medicare," says Alexandrov. "To make prog- ress here, we need Medicare and third-party payers to recognize that this can be a cost- effective and lifesaving approach." 'Quite a Surprise' Down in Houston they're already incor- porating lessons from the first two years of their MSU, including switching to the telemedicine option. But as far as data, try this: Forty-two percent of the patients being treated by the UTHealth MSU are being treated within the first hour of their symptoms. In the control group, that num- ber is zero. "What we can hopefully say we know," says David Persse, MD, Houston's EMS phy- sician director and public health authority, "is that way more patients are being treated within the first hour of their symptoms with a mobile stroke unit than among those who go by ambulance to the hospital." That's particularly exciting in light of another finding observed in Cleveland and Vascular neurologists are a scarce resource, so the Cleveland Clinic turned to telemedicine to connect its stroke unit to physician expertise. Cleveland Clinic

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