COMMUNITY HEALTH
Mobile Stroke Unit is on the road saving lives.
Only a month has passed since a medical emergency left Margie Rangel speechless and unable to walk. Now, she takes daily walks at the park near her home. She’s able to move and think the same as before. Her friends tell her, “You don’t look like you had a stroke.”
“I feel strong,” Rangel said. “Everyone says I almost recovered too quickly.”
Sometimes, her quick recovery is surprising even to her. “It’s like a miracle,” Rangel said.
For the southeast Houston resident, March 25 started off like any other regular morning. After waking up, she headed to the bathroom to brush her teeth. But she “felt a little faint,” so she sat down.
She tried to call out to her husband, Albert, who was asleep in the next room — but no words came out. That’s when she realized she could no longer speak.
Rangel reached for the trash can and began banging it on the wall.
“That woke him up,” she said.
Rangel could not stand, so Albert dragged her back to the bedroom.
That’s the last thing she remembers.
Albert later told her that her eyes rolled back in her head. He called their grandson Michael to come over to help.
“As soon as he saw me, he said, ‘She’s having a stroke,’ ” Rangel recalled.
Three ambulances came, and Rangel was wheeled out on a stretcher.
She has a few flashes of memory. Inside the ambulance, a doctor was visible on a screen, giving orders to the medics on board.
Rangel recalls their talk about a “tPA,” a term she never heard before. “That’s all I remember,” she said.
An injection of tissue plasminogen activator (tPA) is a treatment usually given within the first three hours of a stroke. The drug dissolves the blood clot that causes the stroke — restoring blood flow.
By the time Rangel arrived at the hospital, her blood clot was dissolved, and a doctor was standing by to get her blood pressure under control.
After a few weeks of therapy, she was back up and at it.
Rangel later discovered that the ambulance that transported her was specifically prepared for her medical emergency.
Equipped with telemedicine and the needed tPA injection, she was whisked away in Memorial Hermann’s Mobile Stroke Unit.
“Thank God for the reaction from the stroke unit,” she said. “It might have been worse if they had not been there.”
The Mobile Stroke Unit is the brainchild of Dr. James Grotta. The neurologist serves as director of stroke research at the Clinical Institute for Research and Innovation at Memorial Hermann-Texas Medical Center.
The Mobile Stroke Unit was created in partnership with Memorial Hermann and UTHealth.
Grotta explained that a number of medical advances made it possible.
First, the FDA approved tPA for acute ischemic stroke in 1996. Before that, Grotta said there were no stroke teams around Houston, mainly because there was no treatment.
The only issue with the tPA injection was that it required reaching the patients early, Grotta explained.
“We realized that if this was possible, it had to be done fast,” he said. “The sooner we treated the patient, the better.”
That resulted in a partnership with the fire department, trying to reach individuals with stroke immediately.
Then, Grotta learned a portable CT scanner had been developed in Germany, allowing ambulances to bring the hospital to the patient.
This was the missing piece for the Mobile Stroke Unit, Grotta explained, because patients had to first be diagnosed on a CT scan to determine whether they were having a stroke treatable with tPA or a hemorrhagic stroke.
Grotta connected with Frazer, a Houston-based emergency-vehicle builder, to design the Mobile Stroke Unit, and a $1 million dollar donation from Jim McIngvale, aka “Mattress Mack,” funded the build-out.
In 2014, Grotta introduced the first Mobile Stroke Unit in the U.S. Currently, he said, there are about 20 in the country.
Grotta immediately began a clinical trial, funded by the Patient-Centered Outcomes Research Institute, to evaluate the efficacy of the new specialized emergency vehicle.
“It wasn’t enough to just put the Mobile Stroke Unit in operation,” he said. “We wanted to know if we were making enough of a difference and show that we could really improve stroke care.”
From 2014 to 2020, more than 1,000 patients were studied, including about 800 in Houston. Each individual was followed for a year after the stroke to focus on recovery.
“What we found was that, indeed, we could speed up treatment,” Grotta said.
He explained that the specially equipped ambulance makes it possible to treat a patient within the critical first hour of exhibiting stroke symptoms. The same is not necessarily true in an emergency room, where a few hours can pass before a patient is transported, diagnosed and connected to the doctor on call.
“In the first hour, the blood clot is easier to dissolve and the treatment is better,” Grotta said.
The trial revealed that 33 percent of patients could be treated in that first hour in the Mobile Stroke Unit, compared to 3 percent in the traditional setting.
About 97 percent were treated with tPA in the Mobile Stroke Unit, compared to 79 percent in the hospital.
In addition, about 11 percent more patients treated in the Mobile Stroke Unit completely recovered from their stroke.
“That means that for every 100 patients we treat, 11 more will be completely cured, which is a lot,” Grotta said.
“And there’s no increased risk,” Grotta said.
He explained that patients like Rangel will continue to be studied to determine what extent their treatment translated to a reduced need for rehabilitation and long-term care later on.
“Is it worth the effort, and how do you measure that? You measure it in quality of life gained,” Grotta said. “We’ll have that information by the end of the summer.”
He believes that in the next 10 years, Houston could house three or four mobile stroke units.
Currently, the one unit covers around 70 percent of the city, a 13-mile radius of the Texas Medical Center. The ambulances transport patients to stroke departments at all area hospitals.
“It’s a community effort,” Grotta said. “And we’ll continue to be that way. It’s been successful.”
In stroke care, the phrase “time is brain” has become a common mantra.
The Mobile Stroke Unit — outfitted with brain imaging technology, a lab and telemedicine interface or even a doctor on board — allows efficient treatment, when time is of the essence.
“We can treat people right there on the driveway,” Grotta said. “All they have to do is call 911.”