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Your Healthy Family: Mobile Stroke care: The wave of the future in southern Colorado?

Posted at 5:23 PM, Nov 26, 2018
and last updated 2019-07-09 11:27:38-04

COLORADO SPRINGS – In our last story, we told you how Bob Waddell survived a massive stroke last July.  UCHealth’s Mobile Stroke Treatment Unit (MSTU) played a key role in laying the foundation for the speed of his care.

Bob says, “I’m so lucky that…. (pause) They were in town that day, because I know it’s shared between Aurora half time, so it’s not even always here –this mobile stroke unit,”

Dr. Shaye Moskowitz, an endovascular neurosurgeon at UCHealth Memorial Central Hospital, took over Bob’s care after the MSTU brought him to the hospital.  But how big of a difference did the minutes saved on the MSTU really make in Dr. Moskowitz’s efforts to clear Bob’s blocked blood vessel in his brain once he arrived in the interventional radiology suite?

Dr. Moskowitz says because of the MSTU, much of the care and treatment usually done at a hospital had already been done. The work done on board the unit, along with telestroke capabilities where a physician can see the patient via remote video, means care specific to strokes began immediately.“You know what is going on (with the patient). You know what they have seen, and how severe the stroke is. What they saw on the scan, what the neurologist has said and what they have done.”

When a blood vessel in the brain is blocked, cutting off crucial blood supply, nearly 2 million brain cells die nearly every passing minute, so seconds literally count.

However, not all strokes are involve a blocked blood vessel, which is where the mobile stroke unit makes a world of difference in diagnosis and treatment and saving lives. Blocked vessels can be quickly diagnosed on board, and the decision can then be made to give the patient a clot-busting drug called tPA.

Dr. Moskowitz explains: “Everything is time-based; it takes time to get your scan.  Stroke can look like the same thing even when the stroke cause is very different. A bleed in the brain doesn’t need this kind of treatment, so how do you separate who gets the tPA? Truly, initially it is driven by the CAT scanner, which means the faster you get the CAT scan the faster you can get the medication.”

Not only does the scan happen, the results are transmitted to a neurologist who is then teleconferenced in.

Dr. Moskowitz says, “Neurologists are remotely capable of seeing the person doing an exam and asking him questions to make major decisions instantly inside the ambulance itself.”

When a stroke is diagnosed as a blocked blood vessel, the clot busting drug can be given instantly on the unit.  “The medication they have given them by the time they reach our door, we’ve already got everything ready and waiting for that person so we can be down in the emergency room to greet them as they come in the door. The room’s set up and ready to go. There is no delay at all.”

In Bob’s case The MSTU was on scene evaluating Bob within 12 minutes of dispatch.  The clot-busting medication was administered within 12 minutes of Bob undergoing the scan onboard the Mobile Stroke Treatment Unit.  Bob was in the interventional suite, where Dr. Moskowitz mechanically removed the clot, within 35 minutes of arriving at the Emergency Department.

Dr. Moskowitz says, “He was finished with the procedure -finished within three hours of the first moment his symptoms started, which is amazing.  It’s really truly proof the system (of stroke treatment) can be really quick.”

UCHealth’s Mobile Stroke Treatment Unit, which splits its time between Colorado Springs and Aurora, is the only one of its kind in the Rocky Mountain Region and is one of just five units in the United States currently involved in a national stroke study, along with Houston, Memphis, New York (Columbia and Cornell) and UCLA.

While the results of the national study on the effectiveness are still being gathered, in Dr. Moskowitz’s opinion, it’s only a matter of time until there is a MSTU on duty full time in Colorado Springs.  “It’s imminent, not because I know that, but because it’s proven itself time and time again. Yes, it’s a very expensive resource. I don’t pretend that that’s not the case. There’s no question in my mind that this is a public service resource that we have to have.  Yes at the moment it’s still part of a research effort to perhaps prove the obvious, which is bringing the scanner and skills to patient improve times through outcomes.”

It’s the kind of outcome you hope you never have to have, but if it were you in Bob Waddell’s shoes, Dr. Moskowitz says, “In the end I would argue that if it were you, wouldn’t you want everything brought to you, rather than the other way around? Of course you would.”

While Bob recognized the signs of a stroke and knew to call 9-1-1, the immediate care he received on the MSTU and the streamlined care he had at Memorial have made all the difference in his recovery.

Today, Bob is back at work full time and taking on new projects.  “I’m able to do my job again, and it’s not an easy, simple job. My brain is my most valuable organ. It was rather terrifying and concerning when I realized I was having a stroke, what kind of life I might have.”​

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