Mobile Units Saving Time on Crucial Stroke Care

Providing care about 40 minutes faster than regular ambulances, NewYork-Presbyterian's Mobile Stroke Treatment Units help improve patients' chances of recovery.

Time is of the essence when someone is having a stroke. Not only is stroke the top cause of permanent disability in the United States, but it’s also the fifth leading cause of death.

“Time is brain,” says Dr. Michael Lerario, medical director of the Mobile Stroke Treatment Units at NewYork-Presbyterian. “For every minute that we delay getting tPA medication to a patient, which breaks up a blood clot that’s causing a stroke, the patient will lose nearly 2 million brain cells, and the chances of a permanent disability increase.”

With its fleet of three Mobile Stroke Treatment Units (MSTU), specially equipped ambulances with trained teams that can immediately provide care to people who may be having strokes, NewYork-Presbyterian is reducing the time until treatment by approximately 40 minutes, says Dr. Lerario. In an abstract presented at the 2019 International Stroke Conference, Dr. Lerario and his team reported an average decrease in ambulance arrival-to-tPA treatment from 84 minutes for non-MSTU patients to 48 minutes for MSTU patients, all of whom were transported to NewYork-Presbyterian facilities.

If treated within 90 minutes of the onset of symptoms, a stroke victim has a 50 percent chance of making a full recovery. This time-savings, Dr. Lerario explains, shows how effective the MSTUs are in helping improve chances for recovery.

“We believe that Mobile Stroke Treatment Unit care can potentially lead to not only reduced disability,” he says, “but also decreased length of stay in our hospitals and reduced cost to the healthcare system.”

NewYork-Presbyterian is giving tPA to victims of ischemic strokes, which account for approximately 87 percent of all strokes, about three times a week on the different MSTUs. This is about 150 patients a year. Dr. Lerario also cites telehealth in the MTSUs as a major driver in the program’s efficiency. When the program launched in October 2016, the ambulance had a neurologist on board for diagnosis and treatment decisions, but now information, such as CT scan results, are fed to a doctor remotely in real time.

“Telehealth makes the process more efficient because when physicians were on board, we needed a larger group to cover the shifts and they were performing more duties,” he says. “Having the neurologist based at the hospital rather than on the ambulance allowed us to expand our program to serve Manhattan, Brooklyn, and Queens. Now one doctor can staff and communicate with three different ambulances all at the same time.”

NewYork-Presbyterian’s three Mobile Stroke Treatment Units, the largest fleet of such units in the nation, are equipped with the same types of treatment, technology, and diagnostic capabilities that exist in the emergency room of a primary stroke center. This includes CT scans, neurological assessment by a stroke neurologist (via teleconference), and the ability to administer tPA.

“The faster you administer tPA, the better patients do in terms of disability after their stroke,” says Dr. Lerario. “They’re less likely to be disabled. They’re more likely to be able to walk independently. They’re more likely to be discharged to home rather than an assisted living facility. We’re showing that MSTUs are the closest and fastest emergency rooms in these critical scenarios.”

To learn more about the Mobile Stroke Treatment Units, click here.