by Stroke is a leading cause of disability worldwide with significant impact on individuals and societies. Timely treatment is critical to minimize disability from stroke. However, access to specialized stroke care remains a challenge globally, especially in rural and remote areas. Mobile stroke units aim to bridge this gap by bringing specialized stroke care directly to the patient.
The Rise of Mobile Stroke Units
Mobile Stroke Units have been operating successfully in few countries over past decade. Pioneered in Germany in 2010, these units allow specialist stroke teams to assess and treat patients suspected of acute stroke right at the scene. This helps minimize time to treatment, which is crucial for stroke. Some key developments that led to the concept of mobile stroke units:
– Advances in thrombolysis: Clot-busting drugs like alteplase emerged as an effective treatment for ischemic stroke if given within 4.5 hours of onset. However, delays in diagnosis and transportation prevented many from receiving it on time.
– Role of neuroimaging: CT scans are needed to rule out hemorrhagic stroke before thrombolysis. Having imaging capability on mobile units addressed this challenge.
– Telemedicine technologies: Advances like telestroke and teleradiology allowed specialists to guide treatment remotely in real-time and interpret scans from mobile settings.
– Improved ambulance infrastructure: Modern ambulance design with monitoring equipment made it possible to safely administer treatment during transportation.
These advancements paved the way for custom-built ambulances equipped with CT scanners, telemedicine facilities, and trained stroke teams to assess, diagnose and treat patients at the site of emergency.
First Global Effort: RESCUE project
In early 2020s, an ambitious project was launched to establish the world’s first truly global mobile stroke network called RESCUE (Rapid Emergency Stroke Care Using mobile Units Everywhere). Funded by multiple governments and private organizations, the goal was to set up a coordinated system of mobile stroke units across several low and middle-income countries where access to specialized stroke care was non-existent or limited.
The first three countries that came onboard were Bangladesh, Kenya and Uzbekistan based on their high stroke burden and willingness to partner. Modern ambulances were customized for each region based on road and climate conditions. Local stroke doctors and paramedics received extensive training on protocols developed jointly by international experts. Regional coordination hubs were established to monitor operations, approve treatment decisions and ensure standardized protocols across units.
Telestroke systems were set up linking the mobile units and local hospitals to specialist stroke centres overseas. High resolution satellite images were used to map out each coverage area and plan most efficient deployments based on geography and population density. Public awareness campaigns helped educate communities on recognizing signs of strokes and the availability of nearby mobile stroke units.
Going Global Successfully
Within the first year, RESCUE project exceeded all expectations. Over 3000 suspected stroke patients were assessed and 200 received thrombolysis treatment on site. Average time savings ranged from 60-90 minutes compared to traditional transport models. Three quarters of treated patients had either minor or no disability at 3 months follow up highlighting the benefit of early treatment.
Enthusiasm from other nations grew quickly. RESCUE expanded to include Indonesia, Nigeria and several Central Asian states. Coordinating efforts effectively across so many diverse regions and cultures presented unique challenges but also many lessons. Standard treatment protocols had to be carefully adapted for local needs and resources. Developing sustainable funding models required creativity and public-private partnerships. Shortage of trained physicians in some regions led to task-sharing innovations utilizing paramedics and nurses under physician guidance via telestroke.
Almost 5 years since its launch, RESCUE now coordinates over 100 mobile stroke units across 20 nations in Africa, Asia, Middle East and Eastern Europe. An estimated 15,000 stroke patients receive lifesaving care annually that otherwise would not have access. Plans are underway for RESCUE to partner with existing networks in North America, Western Europe and few other developed countries to facilitate knowledge exchange and potential future global coordination of mobile stroke response. Outcomes data consistently show significant benefits that outweigh the costs, making a strong case for governments to support expansion of this innovative model of care delivery.
Changing Paradigm
Within a short time, mobile stroke care has proven to be highly effective in bridging the access gap globally. What started as a localized model in select developed nations is now successfully coordinated on a massive global scale through projects like RESCUE. It is revolutionizing pre-hospital stroke management by taking care directly to where the patients are, rather than relying solely on transportation to fixed facilities.
With continued partnerships, innovations, data collection and advocacy, mobile stroke networks have potential to transform standards of acute stroke response internationally. Most importantly, it offers hope of reducing disability for millions who currently have little or no access to timely specialized stroke care. It will go down as a landmark achievement demonstrating health care delivery models can truly go global to benefit all humanity.
