A mobile stroke unit (MSU) was successfully integrated into a large suburban EMS system, achieving a median first medical contact to thrombolytic therapy time of 26 minutes with consistent time metrics and no patient receiving thrombolytics beyond the 270-minute safety limit.
Key Findings
Results
The MSU had 1,752 total dispatches over five years, of which 717 patients were transported to the emergency department and 91 patients (4%) received prehospital thrombolytics.
Study period: August 1st, 2019 to July 31st, 2024 (five years)
1,752 total MSU dispatches from a County 911 emergency communication center
717 patients were transported to the emergency department
91 patients received thrombolytics prehospital, representing approximately 4% of all dispatches
No patient received thrombolytics beyond the 270-minute safety limit
Results
The median first medical contact (FMC) to thrombolytic therapy time was 26 minutes for patients who received prehospital tPA.
Median FMC to thrombolytic therapy: 26 minutes (IQR 22–31)
Median dispatch to thrombolytic therapy: 38 minutes (IQR 31–43)
Median time from reported last known well to thrombolytic: 71 minutes (IQR 53–136)
Time metrics were described as 'consistent with little variance'
Results
The MSU achieved rapid on-scene imaging and neurology telemedicine consultation times.
Median time from on-scene arrival to CT scan: 9 minutes (IQR 7–11)
Median FMC to neurology telemedicine consultation: 14 minutes (IQR 12–17)
Median time on scene before initiating transport to a comprehensive stroke center: 21 minutes (IQR 18–24)
The MSU is described as 'a specialty ambulance with computerized tomography and telemedicine consultation capable of prehospital treatment of patients with thrombolytics'
Results
Thrombolytic administration was equally distributed between male and female patients, with a median patient age of 73 years.
An equal proportion of men (47%) and women received thrombolytics
The difference in sex distribution was not statistically significant (p = 0.602)
Median age of patients receiving thrombolytics was 73 years (IQR 64.5–83)
Background
The MSU was integrated into a large suburban EMS system involving multiple agencies, distinct from the predominantly metropolitan settings where MSUs have previously been studied.
The study is described as a retrospective observational study of MSU dispatches
The system involved multiple EMS agencies across a large suburban county
Dispatch criteria were defined by ECC caller-interrogation protocols for stroke and dispatcher discretion
Authors note that prior MSU integration research 'has been focused in large metropolitan areas'
Authors call for 'further discussion on the clinical, financial, and operational impact of MSU care in suburban communities'
What This Means
This research describes how a specialized 'mobile stroke unit' (MSU) — an ambulance equipped with a CT scanner and the ability to connect patients via video with neurologists — was used over five years in a suburban county emergency medical system. The MSU responded to 1,752 calls for suspected stroke, transported 717 patients to the hospital, and was able to administer clot-dissolving medication (tPA) to 91 patients directly in the field. The time from first contact with medical personnel to receiving tPA was a median of just 26 minutes, and no patient received the medication outside of the safe treatment window.
The study found that each step in the treatment process — from the CT scan to the telemedicine consultation with a neurologist — was completed quickly and with consistent timing. The patients who received tPA were roughly equally split between men and women and had a median age of 73 years. These results suggest that an MSU can be effectively operated in a suburban, multi-agency EMS environment, not just in large cities where such units have traditionally been studied.
This research matters because faster treatment for stroke can mean less brain damage and better outcomes for patients. Most previous MSU research has been done in big cities, so this study adds important evidence that suburban communities may also benefit from such programs. The authors note that the findings should prompt further conversation about whether the clinical benefits justify the financial and logistical costs of running an MSU in suburban settings.
Wetzel E, Weisner Z, Ulhaq M, Kening M, Wang A, Wydro G. (2026). Curb to Needle Time: A Five-Year Descriptive Analysis Evaluating a Mobile Stroke Unit in a Suburban EMS System.. The western journal of emergency medicine. https://doi.org/10.5811/westjem.62948