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Stroke: Every Second Counts

Northwestern Medicine Mobile Stroke Unit Helps Minimize Stroke Damage

St. Charles, Illinois, resident Barbara Herman was playing bridge with friends at the Pottawatomie Community Center in late 2019 when suddenly she could no longer hold the cards. Her friends quickly recognized the symptoms of a stroke and called 911. Fortunately for Barbara, she lives in an area serviced by Northwestern Medicine's Mobile Stroke Unit, a specialized ambulance with a 16-slice computed tomography (CT) scanner (takes 16 images in one rotation) , telemedicine connections and stroke-specific medications, so she could receive care on her way to Northwestern Medicine Central DuPage Hospital.

Once inside the Mobile Stroke Unit, Barbara underwent a CT scan showing detailed images of her brain to determine if the stroke was caused by a bleed (hemorrhagic stroke) or a blockage stopping blood flow to the brain (ischemic stroke). The team communicated with a Northwestern Medicine stroke neurologist via telehealth and began treatment immediately. Barbara's condition was stabilized in the Mobile Stroke Unit, and she was able to bypass the Emergency Department and be admitted directly to the Intensive Care Unit.

"On average, Northwestern Medicine's Mobile Stroke Unit provides lifesaving treatment 30 minutes faster than traditional transport," says Harish N. Shownkeen, MD, medical director of the Stroke and Neurointerventional Surgery Programs at Central DuPage Hospital. "This early intervention can lead to better outcomes, as every second counts when you are treating a stroke. For every minute that passes without oxygen, another 1.9 million neurons in the brain die."

When it was launched in 2017, Northwestern Medicine's Mobile Stroke Unit was the first of its kind in Illinois and among the first in the United States. The dedicated Mobile Stroke Unit care team is composed of a critical care nurse, a CT technician, an emergency medical technician (EMT) driver and a critical care paramedic.

For a patient with ischemic stroke, the more common type of stroke, the Mobile Stroke Unit is stocked with the lifesaving, clot-dissolving drug tissue plasminogen activator, or tPA. If the blockage is to a major artery of the brain, the patient can bypass the Emergency Department and go directly into the interventional lab to have to the clot removed.

"We are getting a 30-minute head start by bringing the emergency department to the patient," says Dr. Shownkeen. "It is a quantum leap in the way Northwestern Medicine is treating stroke."

In Barbara's case, tests determined a blood vessel was bleeding in her brain causing pressure on her brain tissue, so she was having a hemorrhagic stroke. The Mobile Stroke Unit care team delivered medications to help control the bleed and lower her blood pressure.

After a week at Central DuPage Hospital, Barbara continued to recover at Marianjoy Rehabilitation Hospital, a part of Northwestern Medicine. She was discharged not long before the COVID-19 pandemic began, and despite the lockdown, was able to continue therapy remotely.

Barbara continues to experience weakness in her right arm and says she occasionally struggles to find the right word. However, she is thrilled to have regained the mobility to go out to lunch with friends and participate in Bible study.

"I have learned to adapt to my new reality. We go out for frequent walks, and I'm playing bridge online. I'm so grateful to have my family very close to keep me busy every day," says Barbara.

Part of Barbara's recovery was thanking those involved. In 2021, she and her family spoke at a St. Charles City Council meeting to recognize the Northwestern Medicine Mobile Stroke Unit, St. Charles Fire Department and the St. Charles Park District for their rapid response to her stroke symptoms.

"To see her walking and talking is truly incredible. It is a wonderful feeling to know our actions have given Barbara and her family more quality time together," says Kristen Flubacker, RN, critical care nurse, Northwestern Medicine Mobile Stroke Unit. "It is a team effort, starting with her friends who quickly recognized she was having a stroke and the on-the-scene care from our partners at St. Charles EMS."

Central DuPage Hospital's Mobile Stroke Unit can be directly dispatched by 911 to patients within the hospital's Emergency Medical Services (EMS) area, which includes Carol Stream, Glen Ellyn, Roselle, West Chicago, Wheaton and Winfield. For areas in the secondary region that includes St. Charles, Geneva, Batavia, Elburn and North Aurora, fire protection districts and ambulance services can request the Mobile Stroke Unit for patients who meet stroke criteria.

According to the Centers for Disease Control and Prevention, more than 795,000 people in the United States have a stroke every year. Stroke is a leading cause of death and serious long-term disability. Stroke risk increases with age, but strokes can, and do, occur at any age.

Know the warning signs and symptoms of stroke so that you can act fast if you or someone you know might be having a stroke. The B.E. F.A.S.T acronym, developed by Intermountain Healthcare and implemented by the American Stroke Association, can help you spot the signs of a stroke.

B (Balance): Does the person have trouble with balance? Do they feel dizzy? Are they walking differently?

E (Eyes): Ask them about their eyesight. Do they have vision loss or blurry or double vision?

F (Face): Does one side of their face droop or look uneven? Ask them if their face feels numb. Tell them to smile and note if their smile is uneven.

A (Arms): Is one of their arms weak or numb? Ask them to raise both arms and see if one arm drifts downward.

S (Speech): Ask them to say a simple sentence (such as, "You can't teach an old dog new tricks."). Are they hard to understand? Do they seem confused? Are they having trouble understanding you?

T (Time): If someone has any of these symptoms, call 911 right away. Take note of the time their symptoms first started, and share this information with first responders.

Time is of the essence for stroke care. The sooner someone receives treatment, the better their chance of survival.