In this series of hospital award winners, we're celebrating medical institutions that employ fresh and advanced approaches to patient care.
Stephanie Wimberly was on her way out of the dentist’s office after a routine root canal when something felt very wrong. The right side of her body was weak. When office staff took her blood pressure, it was abnormally high—which was unusual because she didn’t have a history of high blood pressure. Her dentist’s office called an ambulance.
Two ambulance units responded – a traditional ambulance, followed by UCLA’s Mobile Stroke Unit (MSU). The first ambulance assessed Wimberly and told her the symptoms were likely caused by the anesthesia given for the root canal and suggested she follow up later at a hospital or urgent care if she still didn’t feel well. The second ambulance took a closer look.
When MSU arrived on the scene, they began evaluating Wimberly for signs of a stroke. “They flashed a light in my eye and said, oh no, something’s not right,” she says. She was taken into the mobile unit for a CT scan. Unlike a standard ambulance, MSU is equipped with CT imaging, simple lab tests, and a telehealth system. A CT technician, transport nurse, and doctor are all part of the unit. Wimberly says it was different from an ambulance and felt more like an ER.
Hospital on wheels
“The ambulances actually have the capabilities of a primary stroke center on wheels, so it’s in essence bringing the hospital to the patient,” says May Nour, MD, PhD, Medical Director of the UCLA Arline and Henry Gluck Stroke Rescue Program.
The MSU program is the first of its kind in California and on the West Coast. It’s sponsored by the Arline & Henry Gluck Foundation with additional funding from Los Angeles County. The unit gets calls through a partnership with the Santa Monica Fire Department and Los Angeles County Emergency Medical Services Agency and is part of the 911 response. When MSU hears a dispatch for stroke or potential stroke, they attach to these calls and arrive on the scene with the fire engine and ambulance, explains Naur.
Fortunately, Wimberly happened to be in the service area that day for the UCLA Mobile Stroke Unit. It would save her life. Imaging done inside of MSU found a blood clot on the left side of her brain. They were able to administer a Tissue Plasminogen Activator, or tPA, through an IV to break up the clot and restore blood flow. “As soon as she gave me the tPA shot I started to feel better,” Wimberly says. The doctor told her the medicine was doing what it was supposed to, and they were going to take her to the hospital.
Timely, crucial care
When someone is having a stroke, time is critical. “Every minute [and every] second that you’re not treating it, it’s progressively getting worse,” says Kayla Kilani, MPH, RN, BSN, PHN, MICN, Nurse Manager of UCLA Health Mobile Stroke Unit. She explains that if cells are dying, they won’t regenerate. When treatment is delayed, “you can have lasting effects that are going to take a lot of rehab, and you’re not going to get a lot of that function back.”
The ability to treat a stroke on the scene instead of waiting for a traditional ambulance to arrive at a hospital can save precious time. In Wimberly’s case, she says she wouldn’t be here for her kids without the quick, life-saving treatment given to her in the MSU.
To demonstrate the evidence and value behind MSU, UCLA’s MSU took part in a multicenter national trial called Best-MSU that included seven cities. The trial focused on the effectiveness of getting clot-busting medications to patients having an ischemic stroke (which causes a lack of blood flow to the brain) and found that “out of 100 patients treated on mobile stroke units, 27 will have a less disabled outcome,” says Nour. She also cites a cost analysis for MSU that was presented at the International Stroke Conference that showed MSUs, despite being more costly than a typical ambulance, were highly cost-effective when compared to what a patient would spend on a health care journey that included rehabilitation from a debilitating stroke.
Although Mobile Stroke Units have shown their value, the units are still limited both nationally and internationally due to funding, says Nour. She and her team have been working on getting mobile stroke units recognized as places of service so that Medicare will pay for treatment in them.
Wimberly recognizes how fortunate she was to have been in the MSU’s service area that day. After the stroke, she received therapy and was off work for about three months but says things could be a lot worse. In March of 2021, she even had a baby.
Fact checked by Morgan Mullings.