Racing To The Rescue: AGC Members Gain Invaluable Insight About Houston’s Mobile Stroke Unit
“Strokes are the fifth leading cause of death in the United States and the leading cause of disability,” stated Dr. James Grotta, Director of Stroke Research and Mobile Stroke Unit Memorial Hermann Hospital. “This equates to about one person every 40 seconds and all too often, the severity of the stroke can lead to irreparable brain damage.” Dr. Grotta delivered an eye-opening presentation to AGC Houston members at the Patrick J. Kiley Distinguished Speakers series on January 15, 2020.
Dr. Grotta, an internationally-recognized vascular neurologist with over 40 years’ experience in pioneering stroke research and treatment, spoke about why strokes occur, their treatment and the work he and his team are doing through the Mobile Stroke Unit (MSU) – an ambulance that contains a CT scanner and trained personnel that can diagnose and deliver acute stroke treatment directly to a victim.
In 2014, he helped to launch the first MSU in the nation through collaboration with the Houston Fire Department EMS and all stroke centers in Houston. The Houston MSU serves the entire community, not just a single hospital or healthcare system.
The idea to bring an ambulance to stroke victims — which is equipped to diagnose, evaluate and treat patients — was an innovative approach to quickly treating patients in the first hour after an onset of stroke symptoms. Often, he stated, people don’t suspect a stroke when they call 911. Instead, they tell the dispatcher their loved one is sick, has fallen down, or might have had a heart attack. It’s then up to the dispatcher to ask the right follow-up questions to figure out whether to send a mobile stroke unit.
Strokes are brain attacks and occur when the blood supply to the brain becomes blocked. Lack of oxygen cause brain cells or neurons to die within minutes, so acting fast is a matter of life and death. Learning to detect the signs of a stroke victim can help identify the onset of an attack. Dr. Grotta urged the attendees to “remember the acronym FAST:”
- Face drooping: If the person tries to smile, does one side of the face droop?
- Arm weakness: If the person tries to raise both their arms, does one arm drift downward?
- Speech difficulty: If the person tries to repeat a simple phrase, is their speech slurred or strange?
- Time to call 911: If any of these signs are observed, contact the emergency services.
There are two main types of stroke: ischemic and hemorrhagic. In an ischemic stroke, blood flow to the brain is blocked, typically by a blood clot. In a hemorrhagic stroke, a ruptured blood vessel in the brain causes damage. “Both of these treatments are extremely time-sensitive,” he stated. “They also require substantial assessment of the patient before they can be given.” Unless transported to a hospital emergency room, ambulances and paramedics are not equipped to treat stroke victims.
Cutting Treatment Time, Expanding Funding And SMUs
This is where the importance of the Mobile Stroke Unit comes into play. Every Mobile Stroke Unit has a computerized tomography (CT) scanner, which creates images of the brain. Based on these results, a stroke neurologist or radiologist determines what has happened. The Mobile Stroke Unit reduces the time of treatment from a 911 call to about 30 minutes – from detection to treatment.
“When you think about how many neurons people lose, shaving off 30 minutes can be the difference between whether someone can walk or talk, or even between living and dying,” he said. Grotta introduced Stephanie Parker, RN, who is Program Manager for the Houston Mobile Stroke Unit Consortium. Parker gave specific insight into some of the available statistics of stroke victims and treatments. Both she and Dr. Grotta make up the mobile stroke unit as well as a critical care paramedic and a paramedic driver.
Since its inception, the Houston MSU has treated more than 800 Houston stroke patients across Houston. Dr. Grotta has also helped to implement more than a dozen MSUs across the U.S. Currently, the city’s mobile unit covers the greater Houston area and around the country there are approximately 20. These tend to be located in major cities as their limitations are due to the expenses associated with the operation and because services cannot be billed to insurance companies.
Currently he is waiting on research outcomes from a study that is evaluating the treatment outcomes of all MSU in the U.S., including the overall cost savings. The full results should be ascertained in 2021 and Dr. Grotta hopes that federal funding, such as Medicare and through insurance companies, will help to sustain the service and increase the stroke units across the country.
Until then, he and his team rely on funding from endowments, private organizations, individuals and a federal grant to maintain their life-saving operations. An additional $1.44 million is needed to ensure that Dr. Grotta and his team can maintain this valuable community service over the next two years, until it is fully self-sustaining.