The Melbourne Mobile Stroke Unit providing pre-hospital stroke care

Background:
Stroke patients benefit from early intervention. The Melbourne Mobile Stroke Unit (MSU) is the first pre-hospital stroke service in Australia. The MSU has an integrated on-board CT scanner and carries both acute stroke and ambulance personnel. The MSU aims to improve pre-hospital stroke triage, reduce the time to stroke treatment and provide improved access to comprehensive stroke centres through immediate on-site access to specialised staff and multimodal CT imaging.

Methods:
Data, including time metrics, were prospectively collected on all MSU dispatches, and compared to national standards.

Results:
The MSU launched on 20th November 2017 and operates within a 20km radius of The Royal Melbourne Hospital, Australia, delivering patients to 8 primary and comprehensive stroke centres across the city. In the first 6 months of operation, the MSU was dispatched to 604 code stroke calls. 264 (44%) cases were attended, while 340 (56%) were cancelled pre-MSU arrival after an initial paramedic assessment. Of attended calls, 132 patients (50%) received a non-contrast CT scan and 68 (26%) received a Circle of Willis CT angiogram. The MSU delivered pre-hospital thrombolysis to 27 patients (39% of ischaemic stroke<4.5 hours); median scene-to-CT time 21 min, scene-to-needle 42 mins and onset-to-needle 108 mins were substantially faster than the Australian average of 27 min, 72 mins and 156 mins respectively. Additional MSU treatment included anticoagulation reversal (4 patients), blood pressure reduction (10 patients), seizure management (1 patient) and clinical trial enrolment for both haemorrhagic and ischaemic stroke (8 patients). The MSU has reduced inter-hospital transfers by diagnosing large vessel occlusions and neurosurgery candidates in the pre-hospital setting on 27 occasions (19% all stroke patients), bypassing initial hospitals for specialist centres.

Conclusion:
The Melbourne MSU is achieving thrombolysis workflow consistent with comprehensive stroke centres. It has reduced onset-to-needle times and allowed additional patients to receive thrombolysis. Pre-hospital triage has removed transport delays from inter-hospital transfers.


Skye is a Nurse Practitioner and the Nursing Coordinator of the Melbourne Mobile Stroke Unit at The Royal Melbourne Hospital, Victoria. She has an extensive background in critical care nursing, holds a Master’s degree in nursing, and has completed 2 International stroke nursing courses, she is also the first Board Certified Advanced Neurovascular Practitioner in Australia. Skye is the co-chair of the Acute Stroke Nurses Education Network (ASNEN), an organisation dedicated to improving the delivery of evidence-based stroke care, education and networking opportunities for Australian stroke nurses. Her passion is improving hyperacute stroke care, stroke research and stroke education