How NewYork-Presbyterian Is Advancing Crucial Stroke Treatment Throughout The Region

A customized ambulance fleet aims to care for patients just minutes after symptoms appear.

Time was on Eliana Correa’s side when she first experienced symptoms of a stroke in January 2017. Between the time Eliana, a world music singer and songwriter, collapsed in the recording studio while rehearsing and the ambulance’s arrival, only 13 minutes had passed.

Technology also was on her side. Eliana was treated in NewYork-Presbyterian’s Mobile Stroke Treatment Unit (MSTU), an emergency vehicle that is outfitted specifically to treat stroke patients. That allowed Eliana, who says she felt like she was in a state of paralysis at the time, to begin receiving treatment right away; her first dose of a clot-busting thrombolytic drug, or tPA, was administered within an hour of the 911 call.

“She received IV placement, blood work for laboratory studies, a CT scan with radiologist interpretation, and tPA all on board the ambulance,” says Dr. Michael Lerario, medical director of the Mobile Stroke Treatment Unit.

The unit is part of a broader telehealth initiative at NewYork-Presbyterian, designed to make the hospital’s world-class care more accessible and deliver it faster. Now, NewYork-Presbyterian has expanded its fleet of Mobile Stroke Treatment Units, adding one in Queens and another in Brooklyn, making it the first health system in the country to operate three of these advanced units.

Minutes Cost Brain Cells

Time is of the essence when someone is having a stroke, caused by a blockage or rupture of an artery in the brain. Not only is stroke the leading cause of permanent disability in the United States, but it’s also the fifth leading cause of death.

For every minute that passes after blood flow is even partially cut off from the brain, 1.9 million brain cells die because of a lack of oxygen.

Listen to Dr. Michael Lerario, Medical Director, New York-Presbyterian Mobile Stroke Treatment Unit Program

If treated within 90 minutes of the onset of symptoms, a stroke victim has a 50 percent chance of making a full recovery. If treatment is delayed three hours, the odds of a full recovery drop to about half that. At four hours, treatment barely has any benefit at all.

Treating strokes is a priority “because stroke is among the most time-sensitive serious illnesses that we know of. Therefore, rapid diagnosis and treatment in the field is critical,” says Dr. Matthew Fink, neurologist in chief and chief of the Division of Stroke and Critical Care Neurology at NewYork-Presbyterian/Weill Cornell Medical Center, and the Louis and Gertrude Feil Professor and chairman of the Department of Neurology at Weill Cornell Medicine.

According to the National Stroke Association, someone dies from a stroke every four minutes. And a stroke, which can feel like numbness, weakness, or tingling in an arm or a leg, is often shrugged off until it’s too late. More than half of stroke victims treated at NewYork-Presbyterian don’t call 911 to go to the hospital, preferring instead to use Uber or hail a cab, which minimizes the time in which they can be effectively treated after checking into the hospital, says Dr. Fink.

The medical team aboard the hospital’s unit aims to close that window by administering treatment within 60 minutes after symptoms appear and sooner than if patients took their own transportation to the emergency room.

“We refer to that time frame as the golden hour of treatment,” says Dr. Fink. “If we can treat them in under 60 minutes, we’ll have an even higher percentage of people making a complete recovery.”

A Minute-by-Minute Journey

When a call comes in to the New York City 911 system and an operator identifies that someone is likely experiencing a stroke, the operator will deploy the MSTU if the patient is in the area of coverage. Currently, a MSTU operates out of Manhattan at NewYork-Presbyterian/Weill Cornell Medical Center on East 68th Street and NewYork-Presbyterian/Columbia University Irving Medical Center on West 168th Street. On April 30, a second unit began serving the community surrounding NewYork-Presbyterian Queens, and beginning May 28, a third unit will deploy in the community around NewYork-Presbyterian Brooklyn Methodist Hospital.

The vehicle is staffed by two highly specialized NewYork-Presbyterian paramedics, certified by the Regional Emergency Medical Services Council of New York City, a computed tomography (CT) technologist, and a registered nurse. A neurologist is consulted remotely via videoconferencing, an advancement that allows the physician to speak with and view the patient and provide an assessment and recommendations for care. It is designed to significantly reduce the time from the onset of symptoms to the delivery of care, a crucial factor in improving stroke outcomes.

“We now have a neurologist sitting in a command center in the hospital, and that person can evaluate multiple patients at the same time,” says Dr. Fink. “Then the neurologist can direct the ambulance teams to give medications as needed.”

The unit is 2 feet longer than a regular New York City ambulance to fit a CT scanner so the team can take brain scans in the ambulance and then wirelessly send them to the doctors at the hospital.

“We’re using three different wireless network services,” says Dr. Fink. “If one goes down, we’ve got two others in place.” It can take as little as five minutes to take a CT scan in the unit and have a radiologist at the hospital read it.

To date, the MSTU has been deployed 454 times, transported 88 patients, and administered tPA 34 times. Since its launch in 2016, the MSTU has been able to treat stroke victims approximately 40 minutes faster than a standard ambulance transport.

“Preliminary results have been great,” says Dr. Fink. “Some of the patients that we treated early on with a thrombolytic drug literally went home from the hospital the next day completely recovered.”

Patients like Eliana have made quick recoveries thanks to their fast treatment.

Because of the fast response of the MSTU and the medics’ ability to start all the procedures, medications, and exams in the ambulance, says Eliana, “by the time I got to the hospital I was stabilized already. The ‘damage’ was contained and minimized, and the rehabilitation process could start early.”

After two weeks of rehabilitation at home, she could walk and play music and had her movement back. And the song she was recording the day of her stroke?

“I have finished the song and since had two live performances,” she says. “I am forever grateful for the crew of the mobile stroke ambulance and the care and treatment I received at NewYork-Presbyterian.”

Learn more about the Mobile Stroke Treatment Unit fleet.