{"id":4947,"date":"2016-01-06T00:00:00","date_gmt":"2016-01-06T07:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/01\/06\/regions-first-mobile-stroke-unit-gets-ready-to-roll\/"},"modified":"2025-01-17T12:55:37","modified_gmt":"2025-01-17T19:55:37","slug":"regions-first-mobile-stroke-unit-gets-ready-to-roll","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/regions-first-mobile-stroke-unit-gets-ready-to-roll\/","title":{"rendered":"Region\u2019s first mobile stroke unit gets ready to roll"},"content":{"rendered":"
<\/div>

It\u2019s easy to get caught up in the technology inside the new UCHealth Mobile Stroke Treatment Unit (MSTU): the mobile CT scanner; the InTouch Health telemedicine robot; the \u201cpram\u201d \u2013 a bumblebee-yellow patient-carrier that would look at home in the new Star Wars movie; the telescoping outriggers capable of leveling the vehicle on a 10 percent grade.<\/p>\n

But when the MSTU rolls into service on Jan. 13, the success of the region\u2019s first (and just the nation\u2019s third) mobile stroke unit will depend at least as heavily on how well the UCHealth team and partners apply those technologies. That team spans Fort Collins, Denver, and Colorado Springs and includes, among others, mechanics, MDs, dispatchers, and data specialists. They are leaving nothing to chance.<\/p>\n

\"\"
From left, UCHealth’s Mobile Stroke Coordinator Brandi Schimpf, RN, briefs Christopher Smith, RN; CT technologist John Violette; EMT Martha Creazzo; and paramedic Desmond McNeal before a simulated stroke run on Dec. 23, 2015.<\/figcaption><\/figure>\n

Starting December 21, the Mobile Stroke Team launched weeks of simulations \u2013 \u201csims\u201d \u2013 to tie together integration and planning work underway since before the MSTU pulled into Colorado from Texas<\/a> in early July. The simulations put the many parties involved in a mobile stroke deployment to the test under realistic conditions. The ultimate goal, run after run, was to get simulated, clot-busting tissue plasminogen activator, or tPA, into simulated patients as quickly and safely as possible. That way, come Jan. 13, real patients having real strokes can benefit from the precious minutes<\/a> saved by bringing stroke diagnosis and treatment straight to patients rather than bringing patients to the treatment.<\/p>\n

No textbook<\/strong><\/p>\n

\"MSTU
Violette points out details of the Mobile Stroke Treatment Unit (MSTU) to Smith as the MSTU prepares for departure.<\/figcaption><\/figure>\n

The mobile stroke units in Cleveland, Ohio and Houston, Texas have been running since 2014. While there are lessons to be learned from them, the Colorado version is integrated into UCHealth\u2019s Epic electronic health record, among other key differences.<\/p>\n

\u201cThe hard part is there\u2019s no textbook,\u201d said Brandi Schimpf, RN, UCHealth\u2019s Mobile Stroke Unit program manager.<\/p>\n

So Schimpf and many colleagues have written their own, starting with scheduling. During a go-live period from Jan. 13 to March 4, the MSTU will run Monday through Friday, 8 a.m. to 8 p.m., serving patients in Aurora. Then the vehicle will spend half its time based at UCHealth Colorado Springs. It will run Thursday through Tuesday in one city, then the other, transitioning between them each Wednesday.<\/p>\n

In addition to serving different geographies, the unit\u2019s alternating presence and absence will lend itself to understanding the unit\u2019s true impact on stroke outcomes in either city. That will be key data for a mobile stroke clinical trial whose local arm is being led by University of Colorado School of Medicine neurologist William Jones, MD, MS<\/a>, medical director of the University of Colorado Hospital Telestroke Program and the Mobile Stroke Unit.<\/p>\n

What little data there is on mobile stroke looks promising. The world\u2019s first mobile stroke unit, in Homburg, Germany, cut the time from the emergency call to tPA treatment from 73 minutes to 38 minutes. That 35-minute advantage over hospital-based treatment translated into tens of millions of preserved neurons per patient and, by extension, improved prospects for recovery.<\/p>\n

On the ground<\/strong><\/p>\n

\"patient
Schimpf shows a notecard, one of several with patient data for use in MSTU simulations.<\/figcaption><\/figure>\n

The promise of using a revolutionary new tool to improve stroke care is what attracted Martha Creazzo, a UCH emergency medical technician, to join the mobile stroke team.<\/p>\n

\u201cIt\u2019s a change of pace, and just an exciting opportunity to be part of such a cutting-edge thing,\u201d she said.<\/p>\n

\"determining
Smith, right, determines simulated stroke victim Jim Moon’s symptoms in the Aurora Fire Department Station 2 community room.<\/figcaption><\/figure>\n

On a cold late-December morning, Creazzo stood near the MSTU in the UCH loading dock, listening as Schimpf briefed her, paramedic Desmond McNeal, neuro ICU nurse Christopher Smith, RN, and CT technologist John Violette on the day ahead. Violette will be a constant present with the unit, to be spelled only occasionally by a half-time CT tech. Rotating in will be seven EMTs, five paramedics, and six nurses \u2013 including Schimpf, who intends to take mobile stroke shifts in addition to managing the operation. That doesn\u2019t count Jones and a half-dozen neurologist colleagues on the UCHealth Telestroke team, who will beam in to diagnose patients in both Aurora and Colorado Springs.<\/p>\n

It was, for McNeal, Smith, and Creazzo, their first day on the rolling unit. They were scheduled for three runs, destination unknown.<\/p>\n

\u201cToday, it\u2019s a safe environment,\u201d Schimpf tells them. \u201cTake your time.\u201d<\/p>\n

Details<\/strong><\/p>\n

Schimpf then walked through a long, memorized checklist. Ask when the symptoms started (if more than 4.5 hours ago, tPA can\u2019t be administered on the MSTU). Ask about blood thinners (also a problem with tPA, except for warfarin, which is okay). Ask or visually inspect with respect to age and pregnancy and weight. Blood sugar testing should have already been done by Aurora Fire Department first responders; if not, check it in the rig. Note the time of dispatch, of arrival, of decision to treat, of CT start and image-file send. Check vital signs every five to 15 minutes; if the patient ends up on tPA, it\u2019s vitals plus NIH stroke scale<\/a> every 15 minutes.<\/p>\n

There was much more. Schimpf read a list of phone numbers, which all but the simulation-veteran Violette entered into their phones: Telestroke DocLine, Aurora dispatch, University Biophone and charge nurse, Aurora South Biophone and charge nurse.<\/p>\n

\u201cAny other questions? Issues? Anxieties?\u201d Schimpf asked. The assembled shook their heads.<\/p>\n

On the move<\/strong><\/p>\n

\"loading
The team loads the \u201cpatient\u201d into the MSTU.<\/figcaption><\/figure>\n

Creazzo, the EMT, drove; McNeal, the paramedic, sat up front. Violette and Smith were in back. Along for the ride were Schimpf and David Severenuk, UCHealth\u2019s telehealth system architect. He and Schimpf have been working together so much that they joke about calling themselves \u201cCrazy Dave & D.J. B.-Dazzle, droppin\u2019 hot beats.\u201d The past two mornings, there had been wireless connectivity problems at Aurora Fire stations; Verizon engineers would check it out this afternoon; Severenuk suspected some sort of strong Wi-Fi interference.<\/p>\n

\u201cWe\u2019re very dependent on the data service,\u201d Severenuk said, keeping an eye out the MSTU\u2019s side window to keep motion sickness at bay. To no small degree, he and his colleagues were riding in an elaborate, lifesaving mobile app.<\/p>\n

When the rear doors opened at nearby Aurora Fire Station 2 at 12600 Hoffman Blvd., the LiquidSpring suspension system sank the vehicle\u2019s bed about a foot like a kneeling steed. Smith led the way inside a solid metal door to a tile-floored community room. In its center sat Capt. Jim Moon, who was having his seventh simulated stroke that week. He runs operations for Aurora Fire Department EMS. Smith, the nurse, quickly determined facts, ranging from left-sided weakness to a patient weight of 81.5 kilograms, making the decision to treat.<\/p>\n

\"Schimpf
Schimpf talks with Aurora firefighters during the Dec. 23 simulation.<\/figcaption><\/figure>\n

Moon\u2019s colleagues helped McNeal lift Moon to the pram and into the MSTU. Several firefighters came outside to check out the unit and talk with Schimpf, who answered questions and took advice. Bring along a few traffic cones to route traffic around you, one recommended, because \u201cobvious doesn\u2019t work anymore.\u201d<\/p>\n

Lt. Tom McKay, Aurora Fire\u2019s medical support officer, was among them.<\/p>\n

\u201cIt\u2019s new and innovative,\u201d McKay said. \u201cWe\u2019re certainly looking forward to being part of this research project to provide faster care for stroke patients.\u201d<\/p>\n

Back to base<\/strong><\/p>\n

\"InTouch
Neurologist William Jones, MD, in the InTouch Health telestroke robot’s screen during a UCHealth Mobile Stroke Treatment Unit simulation on Dec. 23, 2015.<\/figcaption><\/figure>\n

The 4G connection had started spotty, but now showed a speedy 9 megabits per second.
\nViolette started the CT scan at 9:37 a.m.; by 9:40, Jones, connected in though a laptop computer, had received the scans. Rather than Moon\u2019s head, the images were digital slices of honeydew melon upon which a face had been drawn in blue marker.<\/p>\n

\u201cHoneydews hold up better than pumpkins,\u201d Violette explained.<\/p>\n

En route back to UCH, Moon reclined in the pram, phantom tPA in his bloodstream. Through the monitor, Jones described an issue of the sort that takes a realistic simulation to catch. In Epic, he couldn\u2019t enter the patient\u2019s weight, and without that, he couldn\u2019t enter the tPA dose they had administered. They\u2019ll look into it, Schimpf told his flat-screen image.<\/p>\n

\"The
The team rolls Moon into the UCH ED.<\/figcaption><\/figure>\n

At the UCH Emergency Department, the mobile stroke team disembarked together, rolling Moon into Resuscitation 2. He hopped up from the pram and was gone, headed back to the office until the next stroke. Schimpf explained the details of the ED\u2019s role in mobile stroke to a group of UCH staff.<\/p>\n

Back outside, Violette prepared for the next run.<\/p>\n

\u201cIt\u2019s an amazing setup,\u201d he said. \u201cRather than door-to-needle, it\u2019s symptom-to-needle. To be able to bring the ER to the patient is amazing, to say the least.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

It\u2019s easy to get caught up in the technology inside the new UCHealth Mobile Stroke Treatment Unit (MSTU): the mobile CT scanner; the InTouch Health telemedicine robot; the \u201cpram\u201d \u2013 a bumblebee-yellow patient-carrier that would look at home in the new Star Wars movie; the telescoping outriggers capable of leveling the vehicle on a 10 […]<\/p>\n","protected":false},"author":22,"featured_media":17208,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[8],"tags":[187,184],"class_list":["post-4947","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-mobile-stroke-treatment-unit","tag-neurology"],"acf":[],"yoast_head":"\nRegion\u2019s first mobile stroke unit gets ready to roll - 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