Healing in Motion

by CHERYL SOOHOO | photography by TERESA CRAWFORD
Northwestern Medicine’s Mobile Stroke Unit brings lifesaving care to patients.

Two years ago, Cynthia Reid had just done a load of laundry in her Glen Ellyn, Illinois, home, when she walked into her kitchen and suddenly collapsed to the floor. Her young stepson found her moments later and frantically went for help. “My husband came into the room and said, ‘Give me your hand,’” she recalls. “But I couldn’t move my left side or hand.” Reid had suffered an acute ischemic stroke: A clot was blocking blood flow to her brain. It was 10:30 on a Saturday morning, and with each passing minute, 1.9 million of her neurons were dying from lack of oxygen. She faced the risk of lifelong disability or death.

The multidisciplinary crew is prepared to respond at a moment’s notice and partner with local EMS providers to deliver the highest level of care outside of the hospital.
Cynthia Reid’s life was saved by the speed and skill provided by the Mobile Stroke Unit.

For many individuals experiencing stroke symptoms, a prompt 911 call and ambulance dispatched by local emergency medicine services (EMS) offer the best route to care at a hospital. For those in Chicago’s western suburbs, though, Northwestern Medicine has gone one step further to reduce time to treatment by bringing a “mini-ER” to the patient’s location. In January 2017, Northwestern Medicine Central DuPage Hospital (CDH) unveiled the first Mobile Stroke Unit in Illinois. In its first year of operation, the specially outfitted ambulance bested traditional transport and treatment in a stroke center by delivering lifesaving clot-busting medication between 30 and 40 minutes faster.

“l am very happy with how far I have come since my stroke,” says Reid, now 49, who today has regained most of the mobility on the left side of her body except for her hand. “I am more than grateful to them for saving my life.”

A state-of-the-art vehicle more than double the length and weight of an average ambulance, Northwestern Medicine’s Mobile Stroke Unit features a 16-slice CT scanner that provides detailed brain imaging, telemedicine capa-bilities linked to stroke radiologists and neurologists at CDH and the clot-buster drug known as tissue plasminogen activator (tPA). All of these elements as well as a mobile and hospital-based stroke team allow this on-the-go stroke unit to save more lives and improve outcomes.

Time is of the Essence

Strokes afflict some 850,000 Americans annually, with incidences of the neurological condition increasing each year. By 2025, 1.2 million new cases are expected in the United States. In 1996, tPA became the only Food and Drug Administration-approved drug therapy for breaking up the clot of an ischemic or thrombotic stroke. Used every day in stroke centers nationwide, the IV drug is most effective when administered as soon as an individual or that person’s family member, coworker or neighbor recognizes the symptoms of stroke — from slurred speech and loss of balance to a droopy face or eyelid — and seeks immediate medical attention. If tPA is given within the first 60 minutes following the onset of symptoms, 50 percent of patients return to baseline within days. If given after that critical time, only 25 percent may avoid permanent neurological disability.

A powerful blood thinner, tPA can lead to deadly consequences if used on patients with hemorrhagic stroke caused by a burst blood vessel or other head trauma involving potential bleeding in the brain. Diagnostic imaging via a brain CT scan is essential to correctly identifying the cause of a patient’s stroke before the administration of the drug. While tPA has always been portable, large bulky CT scanners require sensitive calibration to produce accurate images. Only in the past decade have new advances allowed for mobile CT devices that can withstand bumpy roads and still function, with the first mobile stroke units appearing in Europe. Northwestern Medicine Central DuPage Hospital soon saw an opportunity to acquire a Mobile Stroke Unit — one of only a dozen or so in the nation — to positively influence stroke outcomes and ultimately reduce the need for further rehabilitative or nursing home care.

“We wanted to be leaders in utilizing technology as well as give back to our community,” says Harish Shownkeen, MD, who initiated and championed the acquisition of the Mobile Stroke Unit. He serves as medical director of the mobile unit as well as the Stroke and Neurointerventional Surgery Programs at CDH. “The greatest impact is when a 911 call comes, we can be dispatched to a patient’s location and provide diagnosis and treatment within the critical ‘golden hour.’ No time is wasted picking up the patient and bringing them to the hospital before treatment can begin.”

In its first year, the Mobile Stroke Unit team treated 27 percent of eligible patients with tPA within one hour of the onset of symptoms. That percentage has now gone up to 34 percent. The ultimate goal is 50 percent, which Shownkeen acknowledges is influenced by factors beyond their control. “Nothing happens until someone calls 911,” he explains. “The challenge is that less than 30 percent of people can name two signs of stroke. Only some 45 percent of patients call 911. Others don’t call at all and drive themselves to the hospital.”

Promoting stroke public awareness offers an avenue for speeding up diagnosis and treatment. To that end, Shownkeen recently secured a $300,000 grant to launch a community education program in the CDH service area.

LIFESAVING ON THE GO

Equipped with state-of-the-art technology, the mobile unit allows a specially trained crew to rapidly diagnose and treat stroke patients outside the hospital setting.

1

Critical Medication
Care providers have access to stroke-reversing medications and IV pumps for administering specialized medicine typically only found in the hospital.

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Telemedicine on Demand
Encrypted, real-time video conferencing enables live assessments by physicians who specialize in stroke neurology and radiology.

2

CT Scanner
A full-size, hospital-grade CT scanner is capable of providing detailed brain images on the go.

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Critical Supplies
The unit is outfitted with advanced airway management equipment and portable lab equipment that allows for immediate blood-sample analysis

Balancing Act
To ensure the CT scanner images are of the highest quality, hydraulic jacks auto-level the ambulance prior to any imaging studies.

Balancing Act
To ensure the CT scanner images are of the highest quality, hydraulic jacks auto-level the ambulance prior to any imaging studies.

Always Prepared The crew works in tandem with local EMS providers and specialists at the hospital to deliver the appropriate treatment quickly.

Fully Equipped

Compared to the average 22-foot-long ambulance, the 36-foot Mobile Stroke Unit occupies the largest ambulance bay at Central DuPage Hospital. Its hours of operation run from 8 a.m. to 8 p.m., seven days a week. “We developed the schedule to correlate with the peak times when stroke patients come into the hospital,” says Mehr Mohajer-Esfahani, MSN, RN, program manager of the Mobile Stroke Unit. “People often don’t wake up in the middle of the night because of a stroke.”

The Mobile Stroke Unit provides coverage to the hospital’s Emergency Medical Services area, which includes Carol Stream, Glen Ellyn, Roselle, West Chicago, Wheaton and Winfield, and is dis-patched by 911 at the same time as local EMS. Expanding its reach even further, a secondary part-nership allows fire department and other ambulance services outside the service area to request the Mobile Stroke Unit. The location of the patient will dictate where the unit goes — directly to the individual or somewhere along the local EMS’ route to a stroke center. Despite its mobility, the vehicle’s CT scanner can only be operated while the vehicle is motionless and on level ground.

“While we are on our way, local paramedics scan the scene and look for a place where we can park, which could be on the street in front of a patient’s house or a couple of blocks away,” Mohajer-Esfahani says. “The ambulance has hydraulic jacks that help level it out on uneven surfaces.”

During a typical 12-hour shift, the Mobile Stroke Unit team includes a driver who can safely navigate the 33,000-pound vehicle with sirens and lights blaring; a critical care paramedic; a critical care nurse and a CT scanner technologist. The team then uses a direct telemedicine connection to consult with a radiologist and a stroke neurologist at the hospital, who can “set eyes” on and assess the patient in the ambulance. Once it is determined that tPA treatment is needed, the team starts both the infusion process and the ambulance, which will then begin transporting the patient to the hospital. At CDH, the team hands off the patient for additional care and evaluation.

We can be dispatched to a patient’s location and provide diagnosis and treatment within the critical ‘golden hour.’

Harish Shownkeen, MD

FULL CIRCLE

This January, Reid’s father-in-law was sitting in his Carol Stream family room, when he called out to his wife, Mary Ellen, and couldn’t say her name. She immediately sus-pected a stroke and called 911. As in the case of Reid, local EMS was dispatched as well as the Mobile Stroke Unit. Reid’s father spent two days in the hospital. Several months later, Reid reports he is now doing well.

“My in-laws knew about the Mobile Stroke Unit because of me, but what are the odds it would help them too?” Reid says. “I can’t say this enough, but we are so lucky to be in a community that has such a valuable service.