Mobile Stroke Treatment Unit and a race against the clock

May 10th, 2018
Mike O’Donnell plays with his grandkids, left to right, Carrie, Pyper, Mannix and Padraig at a park near his Security, Colorado home Sunday, April 29, 2018. After suffering a stroke at work, Mike O’Donnell received treatment from UCHealth’s Mobile Stroke Treatment Unit. Because of the quick treatment in the mobile unit O’Donnell walked out of the hospital two days later with no deficits. Photo by Mark Reis

That Tuesday, like any other work day, Mike O’Donnell pulled his car into the parking lot of Colorado Springs’ largest U.S. Post Office facility and went to work sorting mail.

O’Donnell is somewhat of a savant when it comes to remembering addresses. The mail that isn’t read by a machine comes to him, and he can look at an envelope and, in a split second, toss it into any one of 750 designated mail slots so the parcel is swiftly delivered by a carrier to the proper address.

In his business, and many others, time matters. As his shift began at 4 a.m. that morning, his understanding of what it means to race against the clock would forever change his life.

A physically fit man, O’Donnell works out and throws the football to his grandson in the front yard on occasion. He’s a passionate volunteer in the Widefield School District, where his wife, Merrie Ellen, works in an elementary school library and many family members have been educated. Over the years, he’s volunteered in sports and reading programs, helping young people to advance and become productive citizens.

Mike O’Donnell plays in his front yard with granddaughter Carrie Sunday, April 29, 2018. After suffering a stroke at work, Mike O’Donnell received treatment from UCHealth’s Mobile Stroke Treatment Unit. Because of the quick treatment in the mobile unit O’Donnell walked out of the hospital two days later with no deficits. Photo by Mark Reis

O’Donnell said there was no mistaking how odd he felt that morning. His right arm felt numb and it was uncooperative – seemed to be weak and a little limp. When his daughter called to remind him to pick up his grandchildren from school that afternoon, he mentioned that he didn’t feel well and was considering going to the hospital.

A former policeman, O’Donnell was no stranger to emergencies and he knew a little about medicine from working side-by-side all those years with firefighters and paramedics. In his mind, he wondered if he was having a stroke, so he walked into the restroom and looked in the mirror to see if he could detect drooping in his face. No droop.

He was familiar with the acronym FAST — F – Facial droop; A – Arm weakness; S – Speech difficulty; and T – Time to call 911 – and when he left the restroom, he told his supervisor, Lucy, that he wasn’t feeling well. She asked him to sit down in the break room.

“Lucy turned a chair around, and I kind of collapsed into the chair,’’ he said. “She called 911 and the dispatcher told her to give me an aspirin – but no water.’’

An estimated 6 to 8 minutes later, paramedics from the Colorado Springs Fire Department arrived. Emergency dispatchers also alerted UCHealth’s Mobile Stroke Treatment Unit, a specially-equipped ambulance operated by a team of stroke experts. On board the ambulance, experts can detect a possible stroke and deliver critical clot-busting medications while the patient is en route to the hospital.

Quick diagnosis and delivery of tPA, a clot-busting drug when given within the first 4.5 hours after a stroke symptoms begin, may prevent the loss of millions of neurons, reducing brain damage and limiting deficits that can occur after a stroke, such as the inability to recognize people, immobility, loss of vision, difficulty with speech and other symptoms.

Mike O’Donnell at home with his wife, Merrie Ellen Sunday, April 29, 2018. After suffering a stroke at work, Mike O’Donnell received treatment from UCHealth’s Mobile Stroke Treatment Unit. Because of the quick treatment in the mobile unit O’Donnell walked out of the hospital two days later with no deficits. Photo by Mark Reis

When paramedics wheeled O’Donnell out of the post office, he saw the Mobile Stroke Treatment Unit outside. The mobile stroke unit has a CT scanner on board and a two-way audio visual communication system, which allows a stroke neurologist at the hospital to examine for a probable stroke and recommend treatment for a patient.

“It was right there in the parking lot,’’ O’Donnell said. “They got me in, hooked me up and the screen came on and the crew spoke to a doctor in Aurora, who asked me to perform tests to raise my arms.

“From the time I started to feel bad to the time I was in the stroke unit, there was maybe a 20-minute window.’’

UCHealth Memorial Hospital caregivers performed a CT scan and transmitted the results to the neurologist in Aurora, who identified that O’Donnell had an ischemic stroke – one caused by a blood clot.

“It wasn’t a hemorrhage, I remember that part. They took my weight and my height. Everything was done right there, and they were explaining what they were doing. They kept talking to me, which helped,’’ O’Donnell said.

Mike O’Donnell throws the football at home with his oldest grandson, Padraig, 13, Sunday, April 29, 2018. After suffering a stroke at work, Mike O’Donnell received treatment from UCHealth’s Mobile Stroke Treatment Unit. Because of the quick treatment in the mobile unit O’Donnell walked out of the hospital two days later with no deficits. Photo by Mark Reis

O’Donnell received the clot-busting drug, tPA and by the time the Mobile Stroke unit arrived at Memorial Hospital Central, O’Donnell had already shown signs of improvement.

“My arm started coming back within an hour, and things started feeling good again,’’ he said.

His wife, who had received a call from their daughter, was waiting in the emergency department when he arrived.

“There was a nurse there poking me every 10 minutes and asking me to read and look at pictures and tell her what I saw. They were asking me ‘what time is it?’ and this went on every 15 to 30 minutes,’’ he said.

He was admitted to Memorial Hospital’s Intensive Care Unit, spent a day there and then was admitted to a neurology unit. He was evaluated by a physical therapist, who determined he did not need rehabilitation therapy because he did not have significant impairment, likely attributed to the rapid treatment.

“I had the stroke on Tuesday morning, and I went home Thursday evening,’’ he said.

O’Donnell did not know about the Mobile Stroke Treatment Unit – the first time he saw it, he needed it.

“Now, I tell everyone who will listen about it,’’ he said. “I was fortunate that it was there when I needed it.’’

The unit is in Colorado Springs two weeks a month, and in Aurora, Colorado, serving patients near UCHealth University of Colorado Hospital, two weeks a month.

A photo of UCHealth's Mobile Stroke Treatment Unit
UCHealth’s Mobile Stroke Treatment Unit

“There’s a national initiative to get people treated within 60 minutes, from the time they get to the door of the emergency department. With the innovation of a mobile stroke unit, our goal is to provide treatment within 60 minutes of stroke symptom onset,’’ said Brandi Schimpf, mobile stroke program and nurse manager.

Nationally, fewer than 2 percent of people having an ischemic stroke are treated within the first hour of the onset of symptoms, Schimpf said. Delays in calling 911, travel time to the hospital, etc., often keep patients from receiving tPA until two, three and four hours after the onset of symptoms.

UCHealth’s Mobile Stroke Treatment Unit is part of a multi-site, national study to determine whether outcomes for patients improve when tPA is given more quickly with the innovation of a mobile stroke unit. Researchers are also investigating whether tPA, if given more rapidly, results in a better outcome for patients – fewer disabilities, reduced financial impact and a decrease in health care utilization.

Schimpf said the other advantage that patients have in Colorado Springs is that UCHealth Memorial Hospital Central is the only Comprehensive Stroke Center in southern Colorado. As the only hospital in the region with multiple teams of neurosurgeons and neuro-interventional physicians on-call 24/7, Memorial has the unique capabilities to quickly and expertly treat every kind of stroke or brain aneurysm.

In O’Donnell’s case, “he literally had a stroke and walked out of the hospital two days later with no deficits, that’s the impact that MSTU is making for patients. Not everyone has that outcome but that’s what our goal is,’’ Schimpf said.

When O’Donnell went back to work at the post office it initially took him a little longer to read addresses and toss envelopes into the 750 mail slots for quick delivery. Over the weeks, however, the time it takes him to sort the mail has steadily improved.

Now more than ever, he knows how much time matters.

 

 

About the author

Erin Emery is a writer for UCHealth and is based in Colorado Springs.