Nation`s First Mobile Stroke Unit to Bring ER to Houston Patients

Feb. 04--Houston doctors Monday unveiled an ambulance designed to diagnose and treat stroke at the site of the emergency, a potential solution to poor outcomes caused by patients arriving at the hospital too late.

The mobile stroke unit, the nation's first of its kind, will respond to appropriate 911 calls within a three-mile radius of the Texas Medical Center as part of a pilot project soon to be launched by the University of Texas Health Science Center at Houston and Memorial Hermann Hospital.

"It typically takes about an hour once a stroke patient arrives in the hospital emergency room to receive treatment," said Dr. James Grotta, director of Stroke Research at Memorial Hermann. "The idea behind this project is to eliminate that hour by taking the ER to the patient."

Grotta's team will analyze the cost-effectiveness of the stroke mobile unit through a three-year study in which they plan to treat about 150 patients. He said if it's proved to be worth the cost, he would hope to have a fleet of five to 10 such ambulances strategically based around the city, each able to reach its destination within 15 minutes.

The program is modeled on an experiment Grotta observed in Germany. In 2012, that team published results of their research showing it significantly trimmed patients' time to treatment.

Time is critical

Trimming stroke patients' time to treatment is considered crucial because with every passing minute almost 2 million brain cells die. Doctors can treat the most prevalent type, ischemic stroke, with the clot-buster tPA, but it must be given within three hours of the first signs of stroke to be most effective. It works better the earlier it is given.

Stroke is the fourth leading cause of death in the United States and a leading cause of disability. It occurs when blood flow to the brain is interrupted by a blockage or a rupture in an artery, depriving brain tissue of oxygen.

The mobile stroke unit, slightly taller than most ambulances and with a more powerful generator, is equipped with a computed tomography (CT) scanner that allows a team member to quickly assess whether the patient is having a stroke caused by a blood clot. It is also equipped with telemedicine capabilities so the doctor can diagnose and prescribe from a central location, though he or she will ride in the unit in the pilot project.

Unit costs $400,000

The fully equipped units cost about $400,000, mostly because of the CT scanner. Noting that stroke costs the health care system about $200,000 annually per person, Grotta said the ambulance would recoup its cost just by getting to two patients in time to prevent debilitating symptoms.

But Grotta acknowledged the study needs to demonstrate such mobile stroke units significantly improve outcomes, work in a heavily trafficked urban area and are economically feasible. The German studies did not look at cost and were inconclusive about outcomes.

Family-run company

The unit was built by Frazer Ltd., a third-generation, family-run Houston company that manufactures emergency vehicles. The couple, John and Janice Griffin, surprised Grotta by offering to help with the project after he pitched the idea at a health science center development board luncheon in March. Grotta was chairman of the institution's neurology department for seven years.

Grotta has raised $1.5 million for the project and estimates he'll ultimately need another $1.5 million to $2 million, some of which could be covered by a National Institutes of Health grant for which is applying.

Copyright 2014 - Houston Chronicle