Transforming Stroke Care: The Mobile Stroke Unit at Memorial Hermann
James Grotta, MD
Board-certified neurologist with Memorial Hermann Medical Group & Director of Stroke Research, Clinical Institute for Research & Innovation Memorial Hermann-Texas Medical Center.
It’s the single most frequent cause of adult disability in the world. Stroke is a medical emergency that often strikes without warning. Patients recount doing seemingly normal daily activities, like brushing their teeth, relaxing at home or working out at the gym and then suddenly being overcome by numbness, weakness or even an inability to speak.
“A stroke manifests suddenly, which is why it’s important to know the symptoms and receive urgent medical attention,” said Dr. James Grotta.
May is Stroke Awareness Month. According to the Centers for Disease Control and Prevention, nearly 800,000 Americans suffer a stroke each year, which amounts to one stroke every 40 seconds.
Stroke symptoms can vary but often include sudden numbness or weakness, especially on one side of the body, along with confusion, trouble speaking or difficulty understanding speech, sudden trouble seeing in one or both eyes, trouble walking, dizziness, loss of balance and headache.
A stroke occurs when blood flow to the brain is blocked or there is sudden bleeding in the brain. There are two types: ischemic stroke, which happens when a blockage cuts off blood flow, and hemorrhagic stroke, which occurs when there is sudden bleeding in the brain. In an ischemic stroke, brain cells start to die because they can’t get oxygen and nutrients from the blood. With a hemorrhagic stroke, the leaked blood puts pressure on brain cells, causing damage.
“Time is crucial in the treatment of a stroke because the longer blood flow is blocked to the brain, the greater the damage. Immediate treatment can help minimize the effects of a stroke and improve the chances of recovery,” said Dr. Grotta.
Finding a way to treat stroke patients immediately has been Dr. Grotta’s mission for more than four decades. To achieve this, he played a key role in developing a specialized ambulance unit that provides treatment before the patient even gets to the hospital.
Ten years ago, under the direction of Dr. Grotta, Memorial Hermann, in collaboration with McGovern Medical School at UT Health Houston, unveiled the Mobile Stroke Unit (MSU); the first specialized ambulance for prehospital stroke treatment in the United States.
“It typically takes up to an hour once a stroke patient arrives in the emergency room to receive treatment. If we can put the emergency room in the ambulance and take the computer tomography (CT) scanner to the patient, we can treat the patient at the scene and save that time,” said Dr. Grotta.
Here’s how the MSU works: if someone is suspected of having a stroke, the Houston Fire Department dispatches the MSU to the patient’s location. Once on scene, the unit works together with the Fire Department Emergency Medical Services to assess the patient’s medical condition. If treatment is needed, the team begins the process onsite. The MSU team includes a specially trained nurse, a CT technologist, a paramedic and a stroke neurologist.
The MSU is equipped with a CT scanner, allowing team members to swiftly assess if a patient is experiencing a stroke caused by a blood clot. If confirmed, they can promptly administer a clot-busting drug to treat the patient.
“Most strokes are caused by a blocked artery in the brain, and we can get rid of that blockage with medication. The faster we give that medicine after the symptoms start, the more likely it is that the patient is going to recover,” said Dr. Grotta.
When stroke patients receive evaluation, imaging, and treatment before ambulance transport to the emergency center, data shows that MSUs increase treatment into the first “golden hour” after stroke onset, nearly doubling the likelihood of discharging patients directly to home after their stroke. This approach results in fewer long-term disabilities for MSU-treated patients, potentially reducing overall health care costs. But for this to occur, Dr. Grotta emphasized that patients or bystanders must call 911 immediately after stroke symptoms start.
“By identifying strokes faster and starting treatment sooner, the MSU saves precious minutes when a stroke patient is losing nearly half a million brain cells per second,” said Dr. Grotta.
“It’s a tremendous benefit to the community, backed by a decade of research.”
The MSU treats an average of one to two patients per day, with more than 1,500 patients treated since the service was launched, all within the city of Houston.
It has evolved over the years. The MSU has updated imaging and treatment capabilities, thanks to philanthropic support from the Memorial Hermann Foundation.
“It’s truly remarkable for the city of Houston, and I’m honored that Memorial Hermann is part of it,” said Dr. Grotta. “We’ve been doing this for a decade now, and I look forward to continuing our mission to provide the best possible care for our patients.”
Once a patient is treated by the MSU, if they are transferred to a Memorial Hermann hospital, they will receive around-the-clock care.
Memorial Hermann is proud to be a leader in stroke care, being the first network of accredited stroke centers in the region and standing among fewer than 30 accredited stroke networks in Texas. Our network of Memorial Hermann Stroke Centers not only ensures high-quality care for stroke patients but also enables Memorial Hermann ERs to receive patients transferred via ground or Memorial Hermann Life Flight® air ambulance. This dedication to excellence in stroke care underscores our commitment to providing positive outcomes for our patients.