Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

中文翻译：

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增强的调度和会合能力使流动性卒中单元的服务区域和患者数量增加了一倍。

介绍

移动性卒中单元（MSU）与紧急医疗服务（EMS）协同现场提供急性卒中治疗。对MSU方法的一种批评是单个MSU的范围有限。休斯敦MSU正在评估MSU的实施，我们开发了一种会合方法作为一种创新的解决方案，以扩大接受治疗的患者的范围​​和数量。

方法

除了直接将911派出MSU到我们7英里集水区的现场，我们还授权了更远的EMS单位来激活MSU。我们还监视了EMS无线电通信，以识别可能的患者。对于这些遥远的患者，MSU在前往中风中心的途中遇到了EMS部门，并在该中间位置对患者进行了治疗。使用Wilcoxon秩和检验比较了现场治疗的患者和通过会合的患者，比较了MSU基站到中风部位的距离分布以及从911预警到组织纤溶酶原激活剂（tPA）推注的时间。

结果

在4年中，在我们的MSU上用tPA治疗了338例急性缺血性中风患者。其中，有169（50％）位在距离MSU基站6.4英里（IQR 6.4英里）的MSU派遣后现场接受了治疗。169例（50％）通过“结节”途径进行了治疗，评估和治疗卒中的中位数为距基础12.4英里（IQR 5.5英里）（p <0.0001）。从MSU警报到tPA推注的时间（分钟）没有差异：现场直播时为36.0±10.0，而会合时为37.0±10.0（p = 0.65）。通过直接911调度发出警报的患者中有13％得到了治疗，而集合点患者则只有44％。

结论

在MSU派遣途径中添加会合方法，可以在不增加延误的情况下，将手术范围和MSU在城市地区治疗的患者数量加倍。