It’s a long way to the nearest neurological department if you live in Lolland-Falster and have a stroke. In fact, you have to go all the way to Roskilde to be treated in a neurological department. This also means that these patients receive treatment later than if they lived, for example, in Roskilde or Lejre.
Region Zealand will now try to solve the problem with the help of a mobile medical unit – a so-called mobile stroke unit – which will be able to examine and initiate treatment of patients, suspected of having a brain hemorrhage or a blood clot in the brain, already on the road.
"This will especially be a huge gain for citizens in the outer areas of Region Zealand, where we see a much higher risk of having a stroke due to differences in risk factors. If we can get them into treatment earlier with a mobile stroke unit, it will clearly reduce the inequality in access to health services that we have today", says Troels Wienecke, professor and senior physician at the Department of Neurology at Zealand University Hospital, Roskilde
First project in Denmark
The project with a mobile stroke unit in Region Zealand is the first of its kind in Denmark and was established as a collaboration between the Department of Neurology at Zealand University Hospital, Roskilde, the Diagnostic Imaging Department, Prehospital Center and Group Digitalization in Region Zealand as well as DTU Electro. The parties are still in the planning phase, but the plan for the future mobile stroke unit is clear:
A mobile stroke unit is a specially equipped ambulance operated by a paramedic and a radiographer, which has equipment to both scan the patient in a mobile CT brain scanner and start thrombolysis treatment (blood clot-dissolving medicine).
Using a network scanner from DTU Electro, the strength of the network over the entire region has been mapped. Based on this knowledge, we now know which locations have the strongest connection and thus optimal conditions for transferring the necessary large amounts of data for fast treatment on the road.
When a possible stroke patient is reported, the regular ambulance will drive off to the patient. The new mobile stroke unit will then meet the ambulance at an agreed upon meeting place where network connection is good. Here the patient is moved into the new unit, where the paramedic and radiographer can scan and carry out rapid blood sample analyzes as well as be on a 5G video connection with a neurologist and radiologist on duty back at the hospital.
"In a mobile stroke unit we can actually carry out all the examinations that we can also do at home in the department. And when the treatment has been started, the patient is moved back into the regular ambulance and driven to Zealand's University Hospital in Roskilde, where the remaining investigation and treatment is carried out”.
More patients can be treated earlier
With the new mobile stroke unit, the hope is that it will be possible to treat far more patients within the time-critical limit of 4.5 hours after the onset of symptoms – and at the same time start even earlier treatment of those who are already treated within the time-critical window.
"For the thrombolysis treatment, we can perhaps start 30 minutes earlier, and for the thrombectomy treatment we can perhaps save up to 75 minutes, because we don’t have to have the patient admitted to Roskilde and then sent onwards to Rigshospitalet or Odense University Hospital. It can be absolutely decisive for whether a person becomes depended on others or can be self-reliant following a stroke", says Troels Wienecke.
"In Denmark, stroke treatment is now so well organized that we may find it difficult to reduce the time much more for how quickly patients can receive treatment after arriving at the hospital. But with a mobile stroke unit, we break the bounds of that, because we can start the treatment before they even reach the hospital.”
Good experiences in Australia
In the past 15 years, good experiences have been gained elsewhere in the world with mobile medical units.
"In Melbourne, Australia, they have a very well-functioning unit, but there are also similar initiatives in countries close to us such as England, Germany and Norway," says Troels Wienecke.
Thanks to their mobile medical units, the Royal Melbourne Hospital in Australia has been able to multiply the number of patients receiving thrombolysis treatment within the first hour of symptom onset – from 1.5 percent to 18 percent. The Australians operate with the concept of "The Golden Hour" - the first hour after the onset of symptoms - as it has proven to be a particularly effective time window to start treatment within, if the patients are to become self-reliant afterwards.
