Innovation in Delivering Acute Stroke Treatment in Resource Rich and Poor Environments and to Vulnerable Populations: Mobile Stroke Units and Telemedicine.

Ketevan Berekashvili, Amanda Jagolino, Christy Ankrom, James Grotta


Mobile Stroke Units and Telemedicine for Delivering Acute Stroke Treatment in Resource Rich and Poor Environments and to Vulnerable Populations


Despite decades of effort to improve acute stroke delivery, acute stroke treatment rates remain low. Innovative strategies have been developed to overcome some of the barriers that exist in acute stroke treatment delivery.  These include Mobile Stroke Units (MSU) with or without telemedicine (TM) capability and TM alone.  The MSU brings the hospital to the stroke patient by equipping an ambulance with a CT scanner for brain imaging, point of care laboratory capability (POC), and a Vascular Neurologist either on board  (OB-VN) or via TM (TM-VN). A MSU with or without TM can facilitate faster evaluation and treatment decisions, earlier administration of therapy, and more accurate triage of the patient to the appropriate facility.  In studies to date, MSUs with TM are feasible, improve patient care including vulnerable underserved populations, and may be cost-effective.   These innovative approaches could be generalizable in improving stroke care in different settings ranging from urban to rural to under-resourced.  However, in under-resourced regions major barriers to delivering acute stroke treatment with or without a MSU are non-availability of expertise, equipment and supplies including tPA drug, insufficient emergency transport systems, and other socio-economic issues.

Further research is required to provide more conclusive evidence on improved outcome and cost-effectiveness in settings where MSUs, with or without TM may be most useful.


acute stroke, mobile stroke unit, prehospital, emergency medical service, telemedicine, thrombolysis, stroke management

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