Mobile stroke unit
Purpose
According to the 'time-is-brain' concept in acute stroke, recanalization of the obstructed blood vessels has to be performed within the very first hours after symptom onset. However, patients mostly come too late to the hospital and, therefore, only a minority of patients (5-10%) obtains the time-sensitive recanalizing treatments, and if so, mostly too late.[2] As a potential solution to the problem of detrimental delays in stroke management the MSU concept was developed enabling diagnosis and treatment directly at the emergency site as opposed to awaiting the patient's arrival at hospital for treatment. By bringing imaging technology and stroke clinical expertise to the scene, teams are able to take advantage of the pre-hospital arrival time by focusing team efforts solely on one patient with suspected stroke.[3][4]
Apart from the earlier start of treatment, knowledge about the type of stroke already in the pre-hospital phase of stroke management allows accurate triage decisions in regard to the most appropriate target hospital, e.g., hospital with or without endovascular or neurosurgical treatment options.
History and current evidence
The MSU concept was first published in 2003 and realized in clinical practice in 2008 by Fassbender et al. at Saarland University, Germany, adhering to current guidelines and legislations.
Frazer, Ltd. a Houston, TX based emergency vehicle builder, designed and built the 1st MSU in the United States in January 2014. Their specialization in on-board generators for EMS vehicles made them the perfect fit to create an emergency vehicle that could handle the needs of a mobile CT scanner. NeuroLogica Corporation, a subsidiary of Samsung Electronics, provides the mCT, CereTom, enabling the ambulance to do critical CT scans to determine the status of the stroke. With input from leading neurologists, Frazer was able to build a functional space on wheels that helps to drastically cut down the time between onset symptoms and treatment.
References
- ^ "Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program". July 27, 2018.
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