Carmen Acosta

Kimberly Curtis
Shawn Massingill
Timothy Miner

Mobile Stroke Unit

Goldshire Hospital
November 29, 2016

Table of Contents
List of Illustrations.....ii
Abstract..iii
Introduction1
Purpose....1
Problem.......1
Description..1-3
Average Cost of Stroke Patient..3
Start up Cost4-6
Mobile Stroke Unit Conclusion..6
Glossary..7-8
Works Cited9






i

List of Illustrations
Figure
1. Mobile Stroke Unit..2
Table
1. AED indicates automated external defibrillator...4-5

ii

Abstract
Stroke is a leading cause of serious long-term disability in the United States. Time, however, is
the biggest enemy. Time decides how quickly one recovers. Time decides if a stroke victim will
lose function of their body, will speak, eat or walk again. New and intriguing data are emerging
regarding pre-hospital stroke care and better qualities of life for those who receive care and
treatment in the minutes following a stroke. The medications that are used to treat blood clots are
deadly to those with active bleeding; this reinforces the urgency in proper differentiation.
Goldshire Hospital is in need of a unit that will determine which type of stroke a patient is
having and deliver the appropriate care within those golden minutes.

iii

Introduction
Purpose
The reason Goldshire Hospital needs an innovative unit is because the sooner a patient receives
the thrombolytic drug the better the outcome of the patients health. There are three different
types of stroke. An Ischemic stroke occurs as a result of an obstruction within a blood vessel,
which accounts for about 86% of all strokes (Neale). Thrombolytic drugs are used to dissolve
blood clots. The thrombolytic drugs limit the damage caused by the blockage of a blood vessel
(stroke). A hemorrhagic stroke is either a brain aneurysm burst or a weakened blood vessel leak
(stroke). Patients experiencing a hemorrhagic stroke may not receive a thrombolytic drug, as it
will cause severe bleeding. A transient ischemic attack is when blood flow to part of the brain
is blocked or reduced, often by a blood clot. After a short time, blood flows again and the
symptoms go away (stroke).
Problem
The problem is that when a patient is experiencing a stroke, they usually do not receive the
proper care in time. When a patient realizes that he/she is having a stroke, critical time is passing.
By the time an ambulance arrives at the scene, transports the patient to the hospital, and the
patient receives a Computerized Tomography (CT) scan to determine what type of stroke the
patient is having, valuable time has already passed and therefore the patient is not able to receive
the thrombolytic drug if appropriate.
Description
According to the Cleveland Clinic, the goal is to shorten the time between the onset of stroke like
symptoms and the delivery of thrombolytic drugs (mobile). The Mobile Stroke Unit (MSU) was
1

created to accomplish this goal. The MSU is an ambulance equipped with a computerized
tomography (CT) scanner, laboratory system, and specialized staff (Fig. 1) (mobile). The staff
includes a paramedic, a critical care nurse, a CT technologist and an Emergency Medical
Service (EMS) driver. It is also equipped with telemedicine technology, which enables a
neurologist to access the patients symptoms, scans, and blood work while in route to the
hospital (mobile).

Fig. 1 . Mobile Stroke Unit (A) External view (B) Internal view with a computed tomography imaging system (C)
Telemedicine unit at center, with laboratory testing equipment on the counter at the right (D) Team in action
(Hiscott, Rebecca. "Telemedicine Helps Diagnose and Treat Stroke in the Ambulance : Neurology Today."
Neurology Journals. Neurology Today, 07 Dec. 2015. Web. 21 Nov. 2016. ).

When a 911 dispatcher receives the call, he/she screens the caller with a set of questions. Based
on these answers, an MSU along with an ambulance are sent to the scene. Once at the scene, the
staff determines which one of the units will be used. If it is determine that the patient is having a
stroke a CT scan is performed and it is reviewed by the doctor who will determined if the patient
2

is a candidate for the thrombolytic drug (Neale). Research has revealed that half of patients
treated with Tissue Plasminogen Activator (tPA) within the first hour after onset of stroke
symptoms recover with minor or no lingering effects, including speech or physical difficulties
(Collette). This first hour of onset of stroke symptoms is commonly referred to as the golden
hour. According to Dr. James Grotta of Houstons Memorial- Hermann Hospital, Fewer than
5 % of all ischemic stroke patients are treated with tPA and only one in 2,000 receive it within
that golden hour (Collette). The procurement of one or more of these units would result in
earlier care and treatment resulting in better patient outcomes, and shorter hospital stays.

Average Cost of Stroke Patient

A stroke is a major cause of death and long-term disability. Depending on the type of stroke and
where it occurred in the brain is the extent of damage it causes. On average a hospital stay as a
result of an Ischemic stroke is around 3-6 days with a cost of $9,100 but may increase if
complications arise (learning). The average cost of tPA is $5,978 per stay. The average cost of
angioplasty and stents is between $11,000 - $41,000. The average cost of blood test is $150,
CT scan $1000, MRI $3,000. Leaving the hospital is not the end of treatment for a stroke patient,
but only the beginning of a long journey to recovery. Rehabilitation centers can cost on average
$322 per day. The long-term negative effects and disabilities resulting from a stroke are
paralysis, problems with sensory input, difficulty using and understanding language, problems
with thinking and memory, and/or emotional disturbances (NINDS). Costs that are associated
with an ischemic stroke average $200,000 for the first year.
3

Start Up Cost
The cost of an MSU is approximately 1.2 million dollars for the first year. The price includes the
cost of the MSU and the salary of the staff needed to operate the MSU. The Goldshire Hospital
will appeal to our donors and raise the money to fund the cost of the MSU and the annual salary
of the professionals that will be needed. Table 1 shows a breakdown of the start up costs
associated with the MSU and the subsequent years as well.

Table 1.
First
Year

Subsequent
Years

Ambulance box (donated)

$82000

$0

Ambulance chassis

$23000

$0

Ambulance customization for MSU

$53000

$0

$0

$1200

Telemedicine equipment (lease)

$24000

$24000

CereTom CT scanner for ambulance

$375000

$0

$0

$30000

Laboratory supplies i-STAT

$12000

$4800

Power Pro X Stryker stretcher

$14000

$0

Zoll X series monitor/AED

$25000

$0

ALS: Ambulance supplies (suction, backboard,

ALS bags, etc)

$7000

$0

Equipment/Supplies

Ambulance maintenance

Warranty/maintenance contract for CereTom

Supply maintenance (oxygen and IV supplies)

$0

$5000

IV pumps

$4500

$200

Gas

$6000

$6000

Insurance

$3000

$3000

Medications (ALS meds, Nicardipine). Excludes

tPA

$4800

$4800

$633300

$79000

Total equipment/supplies

AED indicates automated external defibrillator; ALS, Advanced Life Support; CT, computed tomography; MSU,
Mobile Stroke Unit; and tPA, tissue-type plasminogen activator.
Parker, Stephanie A., Ritvij Bowry, Tzu-Ching Wu, Elizabeth A. Noser, Kamilah Jackson, Laura Richardson, David Persse, and
James C. Grotta. Mobile Stroke Unit Project Budget (Excluding Personnel). Digital image. N.p., 17 Mar. 2015. Web. 20 Nov. 2016.

The $633,000 price for the MSU is the price of the ambulance and the equipment/ supplies
needed to operate the MSU (Establishing). This price will include the Ambulance box, which
will be received through donation. It will also include the customization of the unit to
accommodate the equipment, such as the addition of a CT scanner.
To operate the MSU there will be an EMT, Paramedic, Vascular Neurologist, a Critical Care
Nurse, and a CT Tech (Establishing). The total annual salary to staff the MSU will be about
$446,000. The EMT and the Paramedic each have an annual salary of $36,050 (Emergency). The
Vascular Neurologist annual salary is $187,200 (Physicians). For a Critical Care Nurse the
annual salary would be $105,200 (Nurse). Finally, the CT Tech will have an annual salary of
$81,600 (Radiologic).
After the initial trial of the MSU the neurologist will no longer have to be on board the unit, as
the telecommunication system will allow real-time video monitoring. Using the
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telecommunication system not only allows the neurologist to view the patients scans and advise
immediately, but allows the doctor to be available at the hospital floor as well.
MSUs have been largely funded by private donations from grateful recipients of the service and
a large grant from the American Heart Association. Recently, however, Patient-Centered
Outcomes Research Institute, an independent nonprofit organization, announced a 6.8 million
dollar grant to support patient-centered research in Denver, CO and Memphis, TN (Collette).
This nonprofit organization plans to launch a five-year study of the outcomes of about 700
patients. We would like to appeal to this organization as well.

Mobile Stroke Unit Conclusion

We propose that our hospital is ready and able to join these other organizations in discovering
the latest research and furthering the good work already in progress while improving the lives of
the people we serve. The exciting new research has shown promising results for Hospitals and
Emergency Medical Services (EMS) acquiring Mobile Stroke Units (MSU). We would like to
formally recommend the acquisition of one of these units for our organization.

Glossary
angioplasty - surgical repair or unblocking of a blood vessel, especially a coronary artery
computerized tomography is an imaging procedure that uses special x-ray equipment to
create detailed pictures, or scans, of areas inside the body.
Emergency medical service (EMS) treatment and transport of people in crisis health
situations that may be life threatening.
Emergency medical technician (EMT) a specially trained medical technician certified to
provide basic emergency services before and during transportation to a hospital.
hemorrhagic stroke is either a brain aneurysm burst or a weakened blood vessel leak. Blood
spills into or around the brain and creates swelling and pressure, damaging cells and tissue in the
brain.
ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to
the brain.
neurologist a medical doctor who specializes in treating diseases of the nervous system.
stent - a tubular support placed temporarily inside a blood vessel, canal, or duct to aid healing or
relieve an obstruction.
telemedicine technology allows health care professionals to evaluate, diagnose and treat
patients in remote locations using telecommunication

thrombolytic drugs are used in medicine to dissolve blood clots in a procedure termed
thrombolysis. They limit the damage caused by the blockage or occlusion of a blood vessel.
tissue Plasminogen Activator (tPA) is a protein involved in the breakdown of blood clots.
transient ischemic attack blood flow to part of the brain is blocked or reduced, often by a
blood clot. After a short time, blood flows again and the symptoms go away.

Works Cited
Collette, Rhiannon. "Mobile Stroke Unit Project Receives $6.8 Million from PCORI to Expand
Research in Houston and Beyond." The Business Journals. N.p., 1 Sept. 2016. Web. 21
Nov. 2016.
Edelman, Toby S. "Inpatient Rehabilitation Facilities and Skilled Nursing Facilities: Vive La
Difference! FacebookTwitterGoogle+LinkedInShare." Medicare Advocacy. N.p., 31 July
2014. Web. 29 Nov. 2016.
"Emergency Medical Technicians and Paramedics." Bureau of Labor and Statistics, May 2015.
Web. 20 Nov. 2016.
"Establishing the First Mobile Stroke Unit in the United States ." American Heart Association.
N.p., 17 Mar. 2015. Web. 20 Nov. 2016.
Fassbender, K. "Mobile Stroke Unit." N.p., 2011. Web. 21 Nov. 2016.
Neale, Todd. "Taking Stroke TX on the Road." N.p., 21 Feb. 2014. Web. 29 Nov. 2016.
"Nurse Practitioners." Bureau of Labor and Statistics, May 2015. Web. 20 Nov. 2016.
"Physicians and Surgeons." Bureau of Labor and Statistics, 2014. Web. 20 Nov. 2016.
"Post-Stroke Rehabilitation." Knowstroke. N.p., Sept. 2014. Web. 29 Nov. 2016.
"Radiologic and MRI Technologists." Bureau of Labor and Statistics, May 2015. Web. 20 Nov.
2016.
"Stroke." Centers For Disease Control and Prevention. N.p., 5 May 2016. Web. 21 Nov. 2016.
"Stroke: Your Care in the Hospital." Sutter Health. N.p., 2014. Web. 29 Nov. 2016.