Mobile Stroke Ambulance

[Just Plain Ruff]

http://frazerbilt.com/Videos/watch.php?id=792

So, I didn't get to watch the entire video(and scratchy sound to boot) but this doesn't seem practical for any system but one that has more money than GOD.

Logistics, the delay in gettng patients to the hosptial if they have to wait for the stroke ambulance to get there and many other things.

Does the stroke ambulance get dispatched along with the ambulance and what is criteria and what will the system that uses it, what will their criteria.

And let's not forget the risk of traffic accidents. How would you like to explain the loss of a million dollar piece of equipment because you ran the red light?

[Arctickat]

I had seen this about a year or so ago. It seemed like a neat idea, however the doc doing the interview made some odd assumptions. We have a stroke policy here that dictates if someone fits the criteria we transport direct to the nearest CT location, which is 175km away. We don't stop at the local hospital, we don't stop in Emerg at the CT site. We call the CT site when we're 20 minutes out and they clear the room for our arrival. Then our patient goes straight in for a scan, then he goes to emerg.

If they were to spend that money streamlining the access to CT in the facility, they would likely be able to save more brains.

What do they do when the mobile stroke unit is across town on another call?

What do the medics on scene do when they suspect a stroke? Call the stroke unit and wait for them to come?

Just seems inefficient to me.

[Just Plain Ruff]

Those were my questions as well. I can't see them having more than one or two of these units at the most for the city of Houston. And for Kansas city or Johnson county Kansas, probably just 1.

The cost would outweigh the benefit I would suspect.

Get it out into a rural area and there is absolutely NO way to justify the cost of this thing.

Plus the logistics seem to be impossible to get around in my head. But maybe there are smarter people looking at this than me! that's absolutely possible. My wife tells me that every day!!!!!

[paramedicmike]

Last fall I had the opportunity to sit in on a talk with a group of EMS medical directors on this very topic. While I can't find my notes I remember they were, much to my surprise, pretty excited about the idea.

There were questions about tPA in the field and the potential liability.

[triemal04]

I think it was Boston EMS that did something like this years ago...and then scrapped it because it wasn't making a difference.

Really, given the increasing controversy over when tPA should be given, or even if it should be given for most eligible strokes, this really just shows how out of touch EMS is with both current trends in medicine, and where medicine is going.

Maybe someday people will actually realize that there is a point where trying to do more and more and more passes the point of diminishing returns, and that, even in targeted systems, a lot of the patients that get treated by paramedics would also have the same outcome if they just got a ride to the hospital and treatement there.

[ERDoc]

Personally, this seems like a huge waste of resources that will serve a very small pt population. I'm sure it would be more financially prudent to put another normal ambulance or two on the street for the same price.

[Just Plain Ruff]

Personally, this seems like a huge waste of resources that will serve a very small pt population. I'm sure it would be more financially prudent to put another normal ambulance or two on the street for the same price.

Of course it's a huge waste of resources but every EMS system wants to say "we are doing as much as we can to treat strokes (insert whatever the buzzword of the day is) so this is our answer"

This is a huge expensive TOY that I don't feel will serve but a handful of patients(maybe one a day or two) although, I can imagine that that handful of patients would be very grateful for this toy.

[ERDoc]

I think your number is too high. I'm just not convinced there is any utility to the whole rushed process of working up strokes.

[Just Plain Ruff]

I was giving this the benefit of the doubt, but there will be no doubt, someone with a budget to spend will think this is a great idea and then soon will be out of a job for spending money on this money pit.

The only thing that I see this being any way successful is if this is run/PAID for by a university with a grant of some sort and they pay all the expenses. As soon as they can prove that it would be profitable or at least not a huge drain on current ems/fire resources they can maybe think about moving it off the Universities tit.

[1EMT-P]

I am sorry, but I just can't see wasting resources on a stroke ambulance. I would much rather see the money spent on improving education, equipment, protocols & training for providers. There are some things that we can do to help, including advanced notification for the ED, improved response times, improved stroke awareness education & prevention programs & working to improve access for stroke patients to CT scans.