Ohio Fire Dept., Hospitals Partner to Launch Mobile Stroke Unit

The Columbus Dispatch, Ohio

Mar. 24—When slurred speech, facial droop and other telltale symptoms of a stroke develop in Columbus residents, they soon will be able to receive specialized care before they ever see the inside of a hospital.

The Columbus Division of Fire and the city's three major hospital networks are working together on a new ambulance equipped with specialized equipment and personnel to respond faster to patients having a stroke, when minutes saved can translate into days of healthy living.

"We are going to bring definitive care to your front yard," said Columbus Fire Chief Kevin O'Connor.
Administering care for a stroke faster is critical to improving the quality of life for the patient after the treatment, doctors from each of the hospital networks said.

A 2014 study published in the American Heart Association's journal Stroke determined that every minute saved in delivering stroke treatment can add 1.8 healthy days to a patient's life.

"It is all about minutes. It is all about time," said Dr. B.J. Hicks, vascular neurologist and co-director of the comprehensive stroke program at OhioHealth Riverside Methodist Hospital. "If we can save even an hour, even 30 minutes, off of somebody's treatment, it can be a lifesaving difference."

The city's fire division will dedicate two specially trained paramedics to Columbus' first mobile stroke unit, a $1.2 million ambulance funded by OhioHealth and staffed with either a nurse practitioner or a physician's assistant.
The new ambulance will begin operating by early summer from 7 a.m. to 7 p.m. seven days a week. It will dispatch from a bay near highway access on East 14th Avenue on the Northeast Side, and it will take patients to one of the city's three comprehensive stroke centers: Riverside, Mount Carmel East or Wexner Medical Center at Ohio State University.

"... We are taking hospital work outside of brick-and-mortar and putting wheels under it," said Nate Jennings, OhioHealth's manager of the Mobile Stroke Treatment Unit.

City dispatchers will send the unit when they can determine over the phone that it's needed; otherwise, standard medics can call for it once they are on the scene. Dispatching equipment on the mobile stroke unit will be the same as that used in other fire division units.

Before stroke patients enter the emergency department, treatment already will have begun. The ambulance is outfitted with equipment that will let the on-board staff conduct a CAT scan of the brain, consult remotely with stroke specialists and begin administering medication to treat the stroke.

Patients remain mostly stationary near the center of the unit while equipment and first responders move around them. A terminal with high-definition cameras and a screen flips down from the ceiling. One of six people from OhioHealth's stroke center appears on the screen to help first responders in the ambulance diagnose the stroke and how to treat it.

The CAT scan rolls from its space behind secured straps to envelop a patient's head and check for brain bleeds. Those scans are a key piece to diagnosing a stroke, said Dr. Steven Gentile, a Mount Carmel physician who was part of the task force that worked on the new mobile stroke unit.

Strokes caused by blood clots that cut off circulation to the brain are treated with medication that dissolves the clots, but without the scan, Gentile said, it can be difficult to distinguish between a clot and a ruptured blood vessel. Giving such medication to a patient who has brain bleeding can make it worse.

Doctors who specialize in treating stroke patients will examine patients through a video-conference system that is included as part of the stroke unit. Dr. Vivien Lee, interim director of the Wexner Medical Center's Comprehensive Stroke Center, already does that with 25 emergency departments.

The system allows her to conduct a complete neurological exam from Columbus, moving the robot left and right, or zooming into the patient's pupils.

"It's like FaceTime with a phone, but beefed up with better systems," she said.

On the mobile stroke unit, doctors will be able to access the video-conference system through several devices, including a smartphone.

The hospitals and fire division will study the new stroke unit to make sure it is reducing the amount of time it takes to deliver stroke care, said Dr. Andrew Thomas, chief medical officer at the Wexner Medical Center. They have set up committees to study its effectiveness, and they hope to be part of a larger study of similar units in other cities.

"There's a lot to learn here. That's really what I think we're all interested in, to look at three years from now," he said.

Doctors from all three health systems emphasized that anyone who believes he or she might be having a stroke should immediately call 911.