First Mobile Stroke Unit in the United States!

[scotty512]

Great things happening in the Texas Medical Center this week. The nation's first ambulance with an on-board CT scanner.

[island emt]

interesting concept, But what will the total costs be for this specialty ambulance?

Will the CT scanner add half a million $$$ in costs to the specially built truck?

Who will be staffing the stroke truck?

Are they going to dispatch it to every possible CVA type of call or wait until an ambulance crew arrives on scene and determines that the pt meets criteria for brain infarct?

Can't see how in a city the size of Houston it will save an hour of time to treatment.

[Just Plain Ruff]

I don't see how it will save time either unless they are going to be able to do it all in that one ambulance from CT to final intervention.

[paramedicmike]

Too many questions. Not enough answers.

[rock_shoes]

I don't see how it will save time either unless they are going to be able to do it all in that one ambulance from CT to final intervention.

Unless I misunderstood the good doctor, I believe that is the intention. Identify, intervene, and transport. I would like to know what the staffing model will be for this unit. Two paramedics and a CT tech with radiology/neurology physician consult prior to lytics?

[ERDoc]

What intervention are we talking about? tPA? Intraarterial tPA? I hate when strokes come in because there are so many phone calls that need to be made. It is not a simple as looking at an EKG and seeing a STEMI. Are they going to sit on the scene while the radiologist looks at the films? I don't see this being very useful.

Full Disclosure:I didn't get to watch the video since I am in a place where audio is not available so I may not have all of the info.

[paramedicmike]

The video didn't go into a whole lot of depth about what they plan to do. So I don't think you missed too much in the way of logistics by not being able to see it.

[ERDoc]

Thanks, Mike.

[Quakefire]

Video on the manufacturer website (frazerbilt) says MD, CT Tech, RN and Paramedic on the car. Seeks like a waste of a Paramedic just to sit there and drive. CT and tPA in the driveway prior to transport to stroke center. Give it a few years to find out if they increase survivabilty rates or how close they come to "ideal" outcomes before we can see how effective this is. I was under the understanding that tPA is not the safest drug in the first place, so I wonder how well a "standard" ambulance with a CT scanner in the back can handle those complications.

[ERDoc]

tPA is known to cause head bleeds. The NINDS study showed that about 5.8% of pts that get tPA end up with bleeds and of those patients, 45% end up dying. Let's pretend we just gave tPA in the driveway and start making our way to the stroke center. Suddenly a car blows a red light and flips the ambulance. Can you imagine the potential blood bath that could come from an MVA after getting tPA? Even if there is no external trauma, there is going to be a brain bleed. Personally (with only experience and no studies to back it up) I don't think there is going to be any benefit.