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Mobile Stroke Units

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.

Stony Brook's Mobile Stroke Unit is continuing operations despite the ongoing coronavirus pandemic. Photo from SBUH

Amid the start of new coronavirus testing at hotspots including Wyandanch and North Amityville today, the number of residents testing positive for the virus that causes COVID-19 increased by 960 in the last 24 hours to 24,483.

At the same time, hospitalizations have declined by 45 patients to 1,585.

“That is the key number we have been watching,” Suffolk County Executive Steve Bellone (D) said on his daily conference call with reporters.

The number of people in the Intensive Care Unit also fell by 25 to 537, while the number of people intubated also declined.

The drop in hospitalizations marks the third time in five days that the closely watched gauge has declined, while the increases in the previous two days were smaller than the weekly average in the prior week.

Bellone suggested that these numbers could suggest a “leveling off,” albeit at a high level.

Suffolk County continues to add hospital beds, increasing capacity by 39 to 3,425, with 744 ICU beds.

The number of beds available is now 655 overall, with 112 ICU beds.

The “good news,” Bellone said, is that 152 people were discharged from the hospital in the last day.

At the same time, the county continues to suffer losses stemming from the virus. In the last 24 hours, 40 people have died, bringing the number of deaths to 693.

Earlier today, Gov. Andrew Cuomo (D) extended New York Pause to May 15, which means that schools and non-essential businesses will remain shut through at least that period. Starting tomorrow, residents of New York will be required to wear face masks when they are in public places and they can’t maintain social distancing of at least six feet.

Bellone mentioned several initiatives the county has started to manage the economic and employment recovery.

He described the potential need to change the Suffolk County Tax Act, which is a law that’s been on the books for 100 years that blocks the county’s ability to access tax funds until the middle of the year.

“Because of that, the county has to borrow money to get through the first six months of the year,” Bellone said.

Bellone announced that the county has created a COVID-19 Fiscal Impact Panel, which will analyze the ways the virus is causing damage to the county’s finances. Emily Youssouf, who Bellone described as an “expert in private and public sector finance,” will chair that panel. Youssouf had been a board member for the New York City Housing Authority under the Bloomberg Administration.

Stony Brook Announcements

Stony Brook University said it will continue to operate its two Mobile Stroke Units. The specialized ambulances are available every day from 8 a.m. to 8 p.m. The units allow patient triage and treatment in the field. Clinicians aboard the ambulances can administer a medication that minimizes brain injury at any location and then, when necessary, can transport the patient to the closest facility.

With a stroke, time is critical to save brain cells, explained Dr. David Fiorella, Director of the Stony Brook Cerebrovascular Center and founder of the mobile stroke centers.

Separately, Stony Brook University Hospital recognizes the anxiety patients feel when each health care professional who comes into their rooms is wearing a mask and, often, a face shield that hides most of their face. In one unit of the hospital, care givers will begin wearing staff ID pictures on their gowns so patients can see the face of the staff member providing care. The idea may extend to other areas of the hospital after a pilot period.

The idea, called the Face Behind the Mask, came from Nurse Practitioner April Plank after she started working in a COVID unit

Stony Brook University Hospital plans to launch two mobile emergency room units in the spring designed to treat stroke patients.
Lifesaving service for the community

By Ernest J. Baptiste

Ernest Baptiste

According to a study in the American Heart Association’s journal Stroke, when a blood vessel supplying the brain is blocked, nearly two million brain cells are lost for each minute that passes, making stroke one of the most time-sensitive diagnoses in medicine. The faster blood flow can be restored to the brain, the more likely that a person will have a full recovery.

That said, Suffolk County residents now have one more reason to look to Stony Brook Medicine for the highest level of care for both ischemic stroke (when a clot blocks the flow of blood to the brain) and hemorrhagic stroke (bleeding within the brain tissue).   

This month we are launching Long Island’s first mobile stroke unit program — a revolutionary pre-hospital program designed to provide specialized, lifesaving care to people within the critical moments of stroke before they even get to the hospital.

While new to Long Island, mobile stroke units have successfully reduced stroke disability and have improved survival rates in other major metropolitan areas across the country. Stony Brook Medicine is collaborating with over 40 emergency medical service (EMS) agencies throughout Suffolk County to provide this lifesaving, time-sensitive care.

Each mobile stroke unit is a mobile emergency room with a full crew of first responders, brain imaging equipment and medications. The units also have telehealth capability to Stony Brook University Hospital, which allows our physicians at the hospital to communicate in real time with the crew and patient, and immediately check for a blocked vessel or bleeding in the brain. This helps to markedly accelerate the time needed to make an accurate stroke diagnosis.

The first responders onboard the mobile stroke unit can then begin administering time-sensitive, advanced stroke treatments while the person is en route to the nearest hospital that can provide them with the appropriate level of care. 

The units are in operation seven days a week, from 8 a.m. to 8 p.m., which is the window of time when most stroke calls are received in Suffolk County.

One is strategically stationed at a base station located off of the Long Island Expressway at Exit 57. The other, which will be launched soon, will be stationed similarly off of Exit 68. These locations were chosen for easy east-west and north-south access. The team will take calls within a 10-mile radius of each base, which includes about 40 different communities.

Ernest J. Baptiste is chief executive officer of Stony Brook University Hospital.