Mobile stroke units: Now and in the future
A review article in the September 2021 issue of the Journal of Neurology has highlighted the published benefits of mobile stroke units and suggested possible future directions to be addressed.
The benefits of an MSU
Since the inception of the first mobile stroke unit (MSU) in 2008 in Germany, multiple studies have shown they have the ability to significantly improve outcomes for people who experience a stroke. Specifically, results from Germany, the United States and Australia have found the use of MSUs increases the number of patients treated within the stroke ‘golden hour’. As ‘time is brain’, an urgent response from an MSU improves health outcomes and reduces long-term disability.
A summary of recent findings generated from our Melbourne mobile stroke unit can be found here.
The road (and sky) ahead
The review notes that there are some areas yet to be addressed through the implementation of the MSU model. In particular, it suggests the application of mobile stroke units may be important to improve the outcomes for people who experience a stroke in rural and remote settings. Many studies have shown factors such as delays in transport, distance to nearest stroke centres and not seeking early medical treatment all contribute to poorer outcomes for these individuals. At this stage, there is little published data on what level of impact an MSU could have in these areas, as most of the MSUs currently operate within metropolitan settings.
According to Professor Geoffrey Donnan AO, co-chair of the Australian Stroke Alliance: “We share the authors’ comments relating to the need to ensure high-quality stroke care is accessible for all, regardless of geographical location.
For this reason, we are working closely with members of rural, remote and Indigenous communities to deliver urgent pre-hospital stroke care in culturally appropriate ways.
Australia is at the forefront of MSU design and implementation. Part of the Stroke Alliance’s plan involves the development of air-mobile stroke units, mobile emergency departments which travel to the patient, via helicopters and aircraft. Each will carry cutting-edge lightweight CT scanners (being designed and developed by our partners EMVision and Micro-X), as well as the country’s most advanced telemedicine system. This will link paramedics to city-based neurologists who will offer real-time diagnosis and treatment support. In collaboration with the Royal Flying Doctor Service and ambulances services in each state and territory, this approach will attempt to serve even the most remote communities in Australia, with a trial of air-MSUs scheduled to begin in 2024.
The journal’s review cites the Stroke Alliance’s world-leading work in this area, which was highlighted in a publication in the International Journal of Stroke.
This study was led by Associate Professor Silke Walter, a consultant neurologist and vice-chairperson of the Department of Neurology at Saarland University, Germany. As well, she is a key member of our International Advisory Council.
Discussing this work, Associate Professor Walter says:
An air mobile stroke unit could be a game changer in overcoming the inequality people living in rural and remote areas face when suffering from an acute stroke. Stroke is a treatable disease and we have to develop such novel ideas as to enable everyone to get the necessary specialised care. The Australian Stroke Alliance is a unique project and the only one worldwide aiming to tackle the inaccessibility to specialised stroke care for a whole country and continent.