Stroke affects one in four people internationally in their lifetime. According to the Stroke Foundation over 27,000 Australians experienced stroke for the first time in 2020, equating to one stroke every 19 minutes. As 1.9 million brain cells can be attacked per minute during a stroke, time is brain.
Whilst there are several Mobile Stroke Units operating around the world, most are in the Northern Hemisphere (three in Germany and five in the USA). However, an innovative new stroke management project aimed at cutting treatment times in Australia is Ambulance Victoria’s Mobile Stoke Unit (MSU).
The Case for Mobile Stroke Unit
The MSU is a structured and specialised ambulance featuring a multimodal computed tomography (CT) scanner supported by a point-of-care (POC) testing laboratory and telemedicine strategy. This equips the specialist crews to deliver thrombolysis faster to patients suffering strokes, thereby improving potential outcomes and lessening the requirement for stroke rehabilitation services. Previous research into existing MSUs have consistently demonstrated a reduction in delays to stroke patients receiving thrombolysis (dissolving blood clots).
The Victorian Pilot Program
Launched in late 2017, the MSU is the first of its kind in Australia, and is the result of collaboration between Ambulance Victoria, The Royal Melbourne Hospital, The Florey Institute of Neuroscience and Mental Health, National Stroke Foundation, RMH Neuroscience Foundation, Victorian Government & the National Health and Medical Research Council. The MSU is a custom-built stroke ambulance containing a CT scanner that produces hospital grade brain scans and angiographs, telemedicine audio visual communication that connects onboard staff with hospital neurologists, and thrombolysis capabilities.
Staffed by a Mobile Intensive Care Paramedic (MICA), an Advanced Life Support (ALS) Paramedic, a CT radiographer, a stroke neurologist and a stroke nurse specialist, the MSU attends patients within 20kms of Royal Melbourne Hospital for time saving treatment and transport to specialist stroke facilities. The MSU is dispatched, secondary to an Ambulance Victoria Ambulance, to all suspected stroke cases that fall within a 12-hour window of symptom onset. The MSU may also be dispatched at the request of attending paramedics or MSU staff monitoring radio traffic.
Initially planned as a five-year strategy, the MSU attended more than 2,500 suspected strokes and treated over 1,000 patients in the first two years of operation. The time sensitive nature of stroke means that treatment within the first 60-minutes from symptom onset increased positive outcomes for stroke patients. In the first six months of the Victorian Ambulance MSU operation alone, patients receiving treatment inside this 60-minute “golden window” increased from 2% to 17%. There is also growing evidence that the MSU is a cost-effective project, due to its ability to provide earlier reperfusion than standard care. This would reduce the direct financial impact, mortality and lost well-being caused by stroke, estimated as costing over $30 billion in Australia in 2020 alone.
The research collected by the MSU through the administration of new stroke medications (including recombinant factor VIIa, Tenecteplase and tranexamic acid) to eligible patients with their consent will help shape future stroke treatment in Australia.
Whilst it is widely accepted that the first hour after stroke onset is a major contributing factor in stroke patient outcomes, strategies such as the MSUs are working to reduce the delay in adequate treatment implementation. Established MSUs can access and manage up to four times as many stroke patients within this critical time window when compared to standard hospital treatment. Further to these benefits, the MSUs in operation around the world have enabled a faster referral pathway for patients to access specialist centres, reducing inter-hospital transfer times.
The Victorian Ambulance Service MSU is the first of its kind in the Southern Hemisphere, and the only MSU available to the Australia public. However, as people living in rural areas are 17 % more likely to suffer stroke, the model’s limitation to within 20km of Melbourne’s CBD may require future review. As a pilot program, the Victorian Ambulance Service MSU is demonstrating many benefits to the community. An increased roll out of MSUs across Australian jurisdictions would likely result in a greater stroke treatment delivery.
- Zhao H, Coote S, Langenberg F, Easton D, Stephenson M, Smith K et al. 011 Melbourne mobile stroke unit halves workflow for acute stroke reperfusion therapy. Journal of Neurology, Neurosurgery & Psychiatry. 2019;90(e7):A4.3-A5.
- The Royal Melbourne Hospital [Internet]. The Royal Melbourne Hospital. 2021 [cited 25 May 2021]. Available from: https://www.thermh.org.au/health-professionals/clinical-services/neurology/mobile-stroke-unit
- Stroke Ambulance — Stroke Foundation – Australia [Internet]. Stroke Foundation – Australia. 2021 [cited 25 May 2021]. Available from: https://strokefoundation.org.au/What-we-do/Research/Stroke%20Ambulance
- Stroke ambulance continues to save lives – Ambulance Victoria [Internet]. Ambulance Victoria. 2021 [cited 25 May 2021]. Available from: https://www.ambulance.vic.gov.au/stroke-ambulance-continues-to-save-lives/
- Donnan G, Davis S. Pre-hospital care in stroke: A technological revolution. International Journal of Stroke. 2018;13(6):549-549.