Abstract 54: Reduction in time to Imaging and intravenous Thrombolysis by in-field Evaluation and Treatment in a Mobile Stroke Treatment Unit

Abstract

Background: A Mobile stroke treatment unit (MSTU) with on-site treatment team can provide thrombolysis successfully in a pre-hospital setting more quickly than traditional treatment in the hospital. We compared our experience of patients treated with the mobile stroke unit to treatment of patients brought to emergency department via a traditional ambulance Methods: We implemented a MSTU at our institution starting July 18, 2014. The unit includes a registered nurse, paramedic, emergency medical personnel, and CT technologist. A stroke physician evaluated each patient via telemedicine and a neuroradioloigst and stroke physician remotely assessed images obtained by CereTom mobile CT (Neurologica, Danvers, USA). Data were entered in medical records and a prospective registry. The evaluation and treatment in the first 3 weeks of implementation of MSTU was compared to a control group of patients brought to the emergency department via a traditional ambulance in the preceding 3 months. The time of alarm was the dispatch time by the city emergency medical service. Results: 23 patients were treated in the MSTU group and 34 in the control group. There were no significant differences in age or gender between the groups. The median time for alarm-to-MSTU-arrival-at-scene was 13 minutes (Interquartile range 9-17). There was a significant reduction of median alarm-to-CT scan completion times (41 min in MSTU vs 62 min in controls, p<0.0001) and median alarm-to-thrombolysis times (64 min in MSTU vs 104 min in controls, p<0.008). Six patients (26%) received thrombolysis in MSTU group and 5 (14%) in the controls. There were no early complications of thrombolysis in the MSTU group. Conclusion: Compared with traditional ambulance model, ambulance-based thrombolysis resulted in decreased time to imaging and treatment.