Parker Stephanie A, Kus Tessa, Bowry Ritvij, Gutierrez Nicole, Cai Chunyan, Yamal Jose-Miguel, Rajan Suja, Wang Mengxi, Jacob Asha P, Souders Christopher, Persse David, Grotta James C
McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States.
McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104894. doi: 10.1016/j.jstrokecerebrovasdis.2020.104894. Epub 2020 May 19.
Mobile Stroke Units (MSUs) deliver acute stroke treatment on-scene in coordination with Emergency Medical Services (EMS). One criticism of the MSU approach is the limited range of a single MSU. The Houston MSU is evaluating MSU implementation, and we developed a rendezvous approach as an innovative solution to expand the range and number of patients treated.
In addition to direct 911 dispatch of our MSU to the scene within our 7-mile catchment area, we empowered more distant EMS units to activate the MSU. We also monitored EMS radio communications to identify possible patients. For these distant patients, the MSU met the EMS unit en route to the stroke center and treated the patient at that intermediate location. The distribution of the distance from MSU base station to site of stroke and time from 911 alert to tissue plasminogen activator (tPA) bolus were compared between patients treated on-scene and by rendezvous using Wilcoxon rank sum test.
Over 4 years, 338 acute ischemic stroke patients were treated with tPA on our MSU. Of these, 169 (50%) were treated on-scene after MSU dispatch at a median of 6.4 miles (IQR 6.4 miles) from MSU base station. 169 (50%) were treated by 'rendezvous' pathway with assessment and treatment of stroke a median of 12.4 miles from base (IQR 5.5 miles) (p< 0.0001). Time (min) from MSU alert to tPA bolus did not differ: 36.0 ± 10.0 for on-scene vs 37.0 ± 10.0 with rendezvous (p=0.65). 13% of patients alerted via direct 911 dispatch were treated vs 44% of rendezvous patients.
Adding a rendezvous approach to an MSU dispatch pathway doubles the range of operations and the number of patients treated by an MSU in an urban area, without incurring delay.
移动卒中单元（MSU）与紧急医疗服务（EMS）协作，在现场提供急性卒中治疗。对MSU方法的一项批评是单个MSU的覆盖范围有限。休斯顿MSU正在评估MSU的实施情况，我们开发了一种会合方法，作为扩大治疗范围和患者数量的创新解决方案。
除了将我们的MSU直接通过911调度到我们7英里集水区内的现场外，我们还授权更远距离的EMS单位启动MSU。我们还监测EMS无线电通信以识别可能的患者。对于这些距离较远的患者，MSU在前往卒中中心的途中与EMS单位会合，并在该中间地点治疗患者。使用Wilcoxon秩和检验比较了现场治疗患者和会合治疗患者从MSU基站到卒中地点的距离分布以及从911警报至静脉注射组织纤溶酶原激活剂（tPA）的时间。
在4年多的时间里，我们的MSU上有338例急性缺血性卒中患者接受了tPA治疗。其中，169例（50%）在MSU调度后在现场接受治疗，距离MSU基站的中位数为6.4英里（四分位间距6.4英里）。169例（50%）通过“会合”途径接受治疗，卒中评估和治疗距离基站的中位数为12.4英里（四分位间距5.5英里）（p<0.0001）。从MSU警报至静脉注射tPA的时间（分钟）无差异：现场治疗为36.0±10.0，会合治疗为37.0±10.0（p=0.65）。通过直接911调度警报的患者中有13%接受了治疗，而会合患者中有44%接受了治疗。
在MSU调度途径中增加会合方法可使城市地区MSU的作业范围和治疗患者数量增加一倍，且不会造成延误。
