Day 4: Where in the World (of EMS) is A.J.?

Imagine serving a rural area, knowing that early intervention with stroke patients can save their life, and you can’t get them to the hospital in time. A hospital system in Hamburg Germany developed a mobile stroke (treatment) ambulance to address the issue of suburban and rural stroke patient management and shorten time to treatment — bring the stroke care to the patient.

When I walked up the ambulance shown in this article at the Rettmobile Exhibition in Fulda Germany, I thought I was looking at just another well designed ambulance. But I was wrong. As I gazed inside, I saw a circular device that resembled a CT scanner.

A physician standing nearby soon confirmed that this was no ordinary ambulance. It was a Mobile Stroke Unit, a complete stroke assessment and care unit carried to the scene of suspected stroke cases inside a conventional ambulance chassis.

A compact CT scanner and point-of-care-laboratory and telemedicine system to allow for physician consultation were all installed neatly in this “ambulance”.  While not cheap, the hospital system has found it highly effective.

They have been able to dramatically reduce Call-to-Lab time, Call to CT time and, most importantly, Call-to-Therapy Decision-Advanced Treatment time, reduced from 120 minutes (two hours), to just 30-35 minutes.

The small Point-of-Care-based laboratory analysis machine in the unit allows the crew to do tests such as platelet count, leukocyte count, erythrocyte count, hemoglobin, hematocrit, INR, aPTT, glutamyl-transferase, p-amylase and glucose, rapidly on scene. This, coupled with the compact CT scan results, once reviewed remotely by hospital physicians, results in early pre-hospital IV-thrombolysis as bridging therapy later mechanical recanalization and subsequent IA- thrombolysis in the hospital.

I was initially skeptical because of the high cost for the mobile unit until the physician pointed out that hospitals put up millions of dollars annually to support their emergency helicopter response systems to impact patients that would not otherwise survive; so, why not do the same for stroke patients. With his data showing that only 2-7% of stroke patients receive rt-PA thrombolysis because they arrive at the hospital too late, his concept, and amazing patient outcomes, seemed very logical for systems that cannot get their stroke patients to the hospital in time.

Two examples (both in females in their 60s) of reduced times:

Call-to-Lab time                Call to CT time     Call-to-Therapy Decision-Advanced Treatment time

Patient 1                              34 Mins.             35 Mins.                             35 Mins.

Patient 2                              31 Mins.             33 Mins.                             33 Mins

Stroke Mgmt.                       114 Mins.            81 Mins.                            124 Mins.



Flip through the accompanying Photo Gallery to get an “inside” look at this interesting German innovation.

More from Rettmobil tomorrow! 

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