SMCMA Physician

Mobile Stroke Unit Increases Patients’ Odds of Beating a Stroke

For stroke specialists like Ilana Spokoyny, MD, time is critical. When patients experience a typical acute ischemic stroke, caused by a blood clot in a brain artery, they lose 1.9 million neurons, 14 billion synapses and 7.5 miles of myelinated fibers every minute. Each hour a stroke patient goes untreated, his or her brain ages 3.6 years, in terms of loss of neuron function. 

That loss of brain function is why stroke is the leading cause of adult disability, leaving many stroke patients unable to walk, talk, eat or care for themselves. 

In northern San Mateo County, Mills-Peninsula Medical Center (part of the Sutter Health not-for-profit network) is piloting a specially-equipped and expertly-staffed ambulance called a Mobile Stroke Unit (MSU). The goal is to test whether bringing stroke diagnosis and treatment to patients—rather than waiting for them to arrive at the emergency department—improves outcomes.

Dr. Spokoyny, a Vascular Neurologist with Sutter Pacific Medical Foundation, who serves as Clinical and Research Director for the MSU, explained how advances in imaging make the MSU possible. 

“We have a CT scanner on board, so we can determine if it’s a clot (ischemic stroke), a brain bleed (hemorrhagic stroke), or something unexpected,” she said.

There is also a pharmacy on the unit, which includes the clot-dissolving IV drug tissue plasminogen activator (tPA)—the gold standard for treating ischemic stroke.

In a typical hospital emergency room, a CT scan and neurologic evaluation could take as long as an hour. Combine this delay with time lost before medical attention is sought, and it’s easy to see why patients who could benefit from tPA—the majority of stroke patients as 85 percent of strokes are ischemic in nature—don’t always get it in time. 

For hemorrhagic stroke, the MSU protocol is to initiate early treatment and alert the nearest stroke center to prepare for emergency treatment which may include surgery and additional care.

The MSU officially became part of the 911 response in northern San Mateo County on December 17, 2018. Standard fire department and ambulance staff still respond to every 911 call, but now the MSU is included in those calls where stroke is suspected. The MSU has the full support of the local emergency services and the county EMS Agency. 

For the time being, a Vascular Neurologist rides in the unit. However, future plans are to connect to a neurologist remotely for real-time evaluation using telemedicine. 

In addition to the on-board Vascular Neurologist, the unit is staffed by a Neurointensivist RN, a Certified CT Technologist, and a Certified Paramedic/EMT.

The MSU at Mills-Peninsula Medical Center is one of only seven hospitals in the nation (and the only community hospital) taking part in a multi-center, national clinical trial—The BEST-MSU Study—to help determine if the time-to-treatment saved by the unit will help stroke patients to fare better and if MSUs are cost-effective. “The MSU has the potential to save healthcare dollars both upfront because the patient’s hospitalization is shorter, and long term, due to fewer disabilities,” said Neurologist Nobl Barazangi, MD, PhD, the Co-Medical Director of the program. This innovative pilot will not only serve the residents of San Mateo County but will also help inform best practices in stroke treatment nationwide—impacting the care of thousands.

Emma Dugas is the Communications Coordinator Bay Area for Sutter Health