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Dr. David Fiorella

SC Legislators join Dr. David Fiorella, fourth from right, in congratulating the Mobile Stroke Unit’s efforts after it was launched last year. Photo from William Spencer’s office

In March of last year, Dr. David Fiorella went before the Suffolk County Health Committee chaired by Legislator William “Doc” Spencer (D-Centerport) and announced the launch of Long Island’s first Mobile Stroke Unit program aimed at reducing death of stroke victims. Fast forward 18 months and Fiorella has reported to the same committee Oct. 1 that since deployment, the MSU has been on over 1000 total calls. Findings during the first-year show Stony Brook Medicine’s units have successfully facilitated the diagnosis and rapid delivery of time-critical therapies to stroke patients at the point of care resulting in substantially improved outcomes.

“We are also very grateful to all of the members for the Suffolk County Legislature for their help in promoting the program’s success and look forward to further improving upon these outcomes and expanding this program to service even more residents of Suffolk County in the future,” said Fiorella, a neurointerventionalist and Director of the Stony Brook Cerebrovascular Center and Co-Director of the Stony Brook Cerebrovascular and Comprehensive Stroke Center.  

Fiorella also mentioned their intent to locate two more stroke units to add to the current slate located at Long Island Expressway Exits 57 and 68. Each unit is equipped with telehealth capability to communicate with physicians at Stony Brook University Hospital. When a suspected stroke call comes in, the mobile stroke unit is dispatched and the team works quickly to determine the type of stroke the patient is experiencing using the features on board including a CT scanner and CT angiogram. Once that is determined, first responders in the unit can begin administering time-sensitive stroke treatments.

Data from the program further shows stroke patients transported by the MSU had much greater rates of discharges directly from the hospital to home after treatment, higher rates of independent clinical outcomes after stroke and much lower rates of death from stroke when compared to national averages, county average, and Stony Brook’s own data preceding the MSU program.   

“The work that Dr. Fiorella and his team are doing is extraordinary,” Spencer said. “The reduced time it takes their units to reach and care for stroke victims is yielding measurable improvements to the lives they touch.”

Spencer also noted the legislature’s goal in expanding the program. 

Strokes are a major public health concern nationwide. Every 40 seconds, someone in the United States suffers a stroke and every four minutes someone dies on one, according to the American heart Association.

Dr. David Fiorella and Dr. Eric Niegelberg are spearheading the Mobile Stroke Unit Program. Photo provided by Stony Brook University

By Daniel Dunaief

In June, Diana Squitieri of Holbrook wasn’t making sense. Her son Joe noticed that she was also stumbling while her face was drooping.

When he brought her to his car to take her to the hospital, she became so disoriented that he asked his wife, Erin, to call 911. That decision, and the new vehicle that arrived, may have saved her life.

A Stony Brook University Hospital mobile stroke unit, which went into service two months before Squitieri’s symptoms developed, immediately started assessing her symptoms.

Each of the two units is a mobile stroke emergency room, which allows Stony Brook doctors to determine whether the patient has a blocked vessel or bleeding in the brain.

If the process of getting to the hospital and determining her condition had taken any longer, Joe Squitieri is convinced he “could have been burying her.”

For bringing these two stroke units to Suffolk County, the TBR News Media is pleased to recognize the team of medical professionals at Stony Brook Medicine who provide life-saving care for stroke victims.

The Squitieri family. Photo provided by the Squitieri family

Suffolk County is “one of only a few places in the entire United States to have these units,” said Dr. David Fiorella, the co-director of the Stony Brook Cerebrovascular Center.

Stony Brook hopes to add a third unit within the next year.

Through the end of September, the two units had received 550 calls. Of those, about half of the patients had a stroke. Some received anti-clotting drugs while in transit to the hospital, while an evaluation of others en route alerted surgeons to the need for rapid intervention.

Every minute during a stroke could endanger as many as two million brain cells, Fiorella said. That means cutting down on the time to receive medicine or to have surgery potentially saves millions of brain cells, which can improve the quality and quantity of a person’s life.

Squitieri is one of 23 people transported in the stroke unit who had an emergency surgical procedure to remove the clot.

Numerous people contributed to bringing these mobile units to Stony Brook, including Eric Niegelberg, the associate director of Operations for Emergency Services and Internal Medicine; Michael Guido, the co-director of the Stroke Center; Eileen Conlon, the RN coordinator of the stroke unit; and Carol Gomes, the interim CEO of Stony Brook Hospital.

Niegelberg appreciated Fiorella’s efforts.

“It was only through [Fiorella’s] leadership and perseverance that we were able to launch this program,” Niegelberg said in an email. Fiorella spent considerable time meeting with county legislators, EMS committees and EMS agencies to rally support for this program.

Fiorella appreciated the joint effort that made this lifesaving service possible. He was grateful that Gomes “saw the value” of this service. “Without her dedication, this would never have happened.”

Gomes believes the stroke units provide “an extraordinary medical service” while improving the quality of life for the community, she wrote in an email.

The mobile stroke units, which have four specialized personnel on board, are equipped with technology that allows Stony Brook neurologists to examine and diagnose each patient.

The outcomes for patients are better because of the earlier delivery of care, Fiorella said. Hospital stays are also shorter, lowering the cost of care.

Squitieri and her son Joe are thankful that the mobile stroke unit arrived at her home when it did.

Diana Squitieri recalled being scared during her stroke and said the crew took “wonderful care of me.”

Joe Squitieri called the stroke unit a “godsend.”

 

 

Dr. David Fiorella and Eric Niegelberg. Photo from Stony Brook Medicine

As American Heart Month kicks off in February, Stony Brook Medicine is finalizing plans to provide speedy help to stroke victims in Suffolk County.

“When a blood vessel supplying the brain is blocked, it is estimated that nearly two million brain cells are lost for each minute that passes, making stroke the most time sensitive diagnosis we have in medicine.”

— Dr. David Fiorella

The Stony Brook Cerebrovascular and Comprehensive Stroke Center and the Stony Brook Renaissance School of Medicine’s Department of Emergency Medicine will launch Long Island’s first mobile stroke unit program in March. The program will include specially equipped ambulances that will be strategically based along the length of the Long Island Expressway, taking calls within 10 miles of their bases.

The hope is to ensure response times of 20 minutes or less.

“When a blood vessel supplying the brain is blocked, it is estimated that nearly two million brain cells are lost for each minute that passes, making stroke the most time sensitive diagnosis we have in medicine,” said Dr. David Fiorella, director of the stroke center and professor of neurological surgery and radiology at the Renaissance School of Medicine. “The faster we can restore blood flow to the brain the more likely that the patient will have a full recovery.”

The units will be available seven days a week from 8 a.m. to 8 p.m., which is the window of time when most stroke calls are received.

Eric Niegelberg, associate director of Operations for Emergency Services and Internal Medicine, said an evaluation was completed to choose what time frame the mobile units would be available.

“We evaluated 911 ambulance call volume by area in the county and combined that data with what we felt was a reasonable response distance and time.”

— Eric Niegelberg,

“We looked at actual data for five years and historically the highest percentage of stroke calls come in during that time frame,” he said, adding once the program begins Stony Brook Medicine will continue to evaluate data and modify the hours based upon current call volume.

While the first unit will be deployed at Exit 57 on the LIE sometime between mid-to-late March, the second will not be in use until April and will be set up at Exit 68.

“The locations were chosen based upon call volume,” Niegelberg said. “We evaluated 911 ambulance call volume by area in the county and combined that data with what we felt was a reasonable response distance and time. Based upon this analysis the two locations were chosen. We did want locations that would provide easy North-South and East-West access.”

The units will include an in-ambulance care team, telemedicine system that enables emergency physicians and neurologists to see the patient via audio/visual conferencing, CT scanner for a standard scan and CT scan angiogram, which allows doctors to check for bleeding in the brain immediately.

Robert Simpson, district manager of Medford Volunteer Ambulance, said the mobile stroke units would be valuable to emergency response workers.

“As an EMS provider, we are always looking for ways to enhance treatment to patients,” Simpson said. “I think that it will definitely be an asset to us, especially for patients with strokes. As they say, ‘Saving time, saves the brain.’ Minutes count when someone is having a stroke as far as being able to enhance their chances of survival.”

According to Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, stroke is the fifth leading cause of death in the United States, killing about 140,000 Americans each year.