Stephanie A Parker1, Ritvij Bowry1, Tzu-Ching Wu1, Elizabeth A Noser1, Kamilah Jackson1, Laura Richardson1, David Persse1, James C Grotta2. 1. From the Department of Neurology, University of Texas-Houston Medical School (S.A.P., R.B., T.-C.W., E.A.N., K.J., D.P.); Frazer Ltd, Houston, TX (L.R.); Department of Emergency Medicine, City of Houston Emergency Medical Services, Texas (D.P.); and Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.). 2. From the Department of Neurology, University of Texas-Houston Medical School (S.A.P., R.B., T.-C.W., E.A.N., K.J., D.P.); Frazer Ltd, Houston, TX (L.R.); Department of Emergency Medicine, City of Houston Emergency Medical Services, Texas (D.P.); and Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.). James.c.grotta@uth.tmc.edu.
Abstract
BACKGROUND AND PURPOSE: Recently, the Mobile Stroke Unit (MSU) concept was introduced in Germany demonstrating prehospital treatment of more patients within the first hour of symptom onset. However, the details and complexities of establishing such a program in the United States are unknown. We describe the steps involved in setting up the first MSU in the United States. METHODS: Implementation included establishing leadership, fund-raising, purchase and build-out, knitting a collaborative consortium of community stakeholders, writing protocols to ensure accountability, radiation safety, purchasing supplies, licensing, insurance, establishing a base station, developing a communication plan with city Emergency Medical Services, Emergency Medical Service training, staffing, and designing a research protocol. RESULTS: The MSU was introduced after ≈1 year of preparation. Major obstacles to establishing the MSU were primarily obtaining funding, licensure, documenting radiation safety protocols, and establishing a smooth communication system with Emergency Medical Services. During an 8 week run-in phase, ≈2 patients were treated with recombinant tissue-type plasminogen activator per week, one-third within 60 minutes of symptom onset, with no complications. A randomized study to determine clinical outcomes, telemedicine reliability and accuracy, and cost effectiveness was formulated and has begun. CONCLUSION: The first MSU in the United States has been introduced in Houston, TX. The steps needed to accomplish this are described.
BACKGROUND AND PURPOSE: Recently, the Mobile Stroke Unit (MSU) concept was introduced in Germany demonstrating prehospital treatment of more patients within the first hour of symptom onset. However, the details and complexities of establishing such a program in the United States are unknown. We describe the steps involved in setting up the first MSU in the United States. METHODS: Implementation included establishing leadership, fund-raising, purchase and build-out, knitting a collaborative consortium of community stakeholders, writing protocols to ensure accountability, radiation safety, purchasing supplies, licensing, insurance, establishing a base station, developing a communication plan with city Emergency Medical Services, Emergency Medical Service training, staffing, and designing a research protocol. RESULTS: The MSU was introduced after ≈1 year of preparation. Major obstacles to establishing the MSU were primarily obtaining funding, licensure, documenting radiation safety protocols, and establishing a smooth communication system with Emergency Medical Services. During an 8 week run-in phase, ≈2 patients were treated with recombinant tissue-type plasminogen activator per week, one-third within 60 minutes of symptom onset, with no complications. A randomized study to determine clinical outcomes, telemedicine reliability and accuracy, and cost effectiveness was formulated and has begun. CONCLUSION: The first MSU in the United States has been introduced in Houston, TX. The steps needed to accomplish this are described.
Authors: Georgios Tsivgoulis; Aristeidis H Katsanos; Pavla Kadlecová; Anna Czlonkowska; Adam Kobayashi; Miroslav Brozman; Viktor Švigelj; Laszlo Csiba; Klara Fekete; Janika Kõrv; Vida Demarin; Aleksandras Vilionskis; Dalius Jatuzis; Yakup Krespi; Chrissoula Liantinioti; Sotirios Giannopoulos; Robert Mikulik Journal: J Neurol Date: 2017-03-18 Impact factor: 4.849
Authors: Christopher T Richards; Baiyang Wang; Eddie Markul; Frank Albarran; Doreen Rottman; Neelum T Aggarwal; Patricia Lindeman; Leslee Stein-Spencer; Joseph M Weber; Kenneth S Pearlman; Katie L Tataris; Jane L Holl; Diego Klabjan; Shyam Prabhakaran Journal: Prehosp Emerg Care Date: 2017-06-29 Impact factor: 3.077
Authors: S Walter; A Ragoschke-Schumm; M Lesmeister; S A Helwig; M Kettner; I Q Grunwald; K Fassbender Journal: Radiologe Date: 2018-11 Impact factor: 0.635
Authors: Alexandra L Czap; James C Grotta; Stephanie A Parker; Jose-Miguel Yamal; Ritvij Bowry; Sunil A Sheth; Suja S Rajan; Hyunsoo Hwang; Noopur Singh; Patti Bratina; Tomas Bryndziar; Andrei V Alexandrov; Anne W Alexandrov; Wendy Dusenbury; Victoria Swatzell; William Jones; Kimberly Ackerson; Brandi Schimpf; Patrick Wright; Amanda L Jagolino-Cole Journal: Stroke Date: 2019-06-11 Impact factor: 7.914
Authors: Silke Walter; Iris Q Grunwald; Stefan A Helwig; Andreas Ragoschke-Schumm; Michael Kettner; Mathias Fousse; Martin Lesmeister; Klaus Fassbender Journal: Curr Atheroscler Rep Date: 2018-08-29 Impact factor: 5.113
Authors: Feras Akbik; Joshua A Hirsch; Pedro Telles Cougo-Pinto; Ronil V Chandra; Claus Z Simonsen; Thabele Leslie-Mazwi Journal: Curr Treat Options Cardiovasc Med Date: 2016-05