Palm Beach may soon add a mobile stroke unit to its fleet of ambulances – an advanced treatment that could significantly reduce the mortality rate among stroke patients on the island.
The Town Council approved the concept at its regular meeting Tuesday, September 8, authorizing the Fire-Rescue Department to pursue negotiations with University of Florida Health, which would lease the vehicle to the town and partner with it during the five-year program.
Fire-Rescue Chief Sean Baker said the mobile stroke unit would be financed partly through a grant from the Foundation for Cardiac and Neurological Care to UF Health and paid for “at no net cost to the town.”
The approximate operating cost of a mobile stroke unit is generally in the range of $10 million to $15 million over five years, according to Baker. All operating costs for the unit would be covered by the program itself.
The vehicle and its crew would be housed at the North Fire Station and dispatched through 911 emergency calls. It could begin operating as early as January, Baker said.
A mobile stroke unit is a specialized ambulance that brings emergency room care and hospital tools directly to a patient experiencing stroke-like symptoms.
It has a portable CT scanner that images the brain on site to determine if the stroke is caused by a blood clot or bleeding. Two-way video connects the on-board medical team with a vascular neurologist at a hospital. Clot-busting drugs and medication that lowers blood pressure can be given immediately in the field.
The mobile stroke unit would be added to the town’s existing advanced life support service and would be dispatched in cases where a patient is reporting or displaying stroke-like symptoms.
“It’s going to allow us to bring advanced capabilities to our EMS system,” Baker said. “We do a great job of recognizing strokes and rapidly transporting patients. But, in this case, we’ll be bringing a hospital-based diagnosis and definitive care directly to the patient.”
The stroke unit would be staffed by two Palm Beach Fire- Rescue paramedics and by a CT-trained nurse and CT technologist. The latter two would not be town employees but would be staffed at the North Fire Station and part of the response team, Baker said.
Telemedicine equipment would connect the unit with board-certified vascular neurologists at UF Health.
The mobile stroke unit would operate from 8 a.m. until 8 p.m. seven days a week. Most strokes occur during those hours, Baker said.
UF Health is a medical clinic with 11 hospitals and hundreds of outpatient clinics that serve north and central Florida. It operates a mobile stroke program with three units based in Gainesville, Jacksonville, and The Villages.
Hunter Beebe is a Palm Beach resident, president of the Foundation for Cardiac and Neurological Care and a member of UF Health’s Board of Trustees.
Beebe told the council that UF Health wants to expand the mobile stroke unit program statewide. The Palm Beach stroke unit would be the first one in a market where there is no UF Health hospital. It would need to be integrated with local hospitals, which would need to be pre-notified when the unit was bringing stroke patients to them, he said.
“I think it will establish a precedent for our fire department to really be on the cutting edge of technologies,” Beebe said. “It’s also important to UF as they roll this out statewide. Rolling it out in Palm Beach will help to create a road map on how to bring it into other communities across the state.”
Stroke treatment is ‘wildly fast’
Dr. Nicolle Davis, director of the mobile stroke program for UF Health, said stroke is the leading cause of adult disability in the United States and the fifth leading cause of death among adults. It kills 16,485 Floridians annually.
Nearly two million brain cells die each minute a stroke goes untreated, Davis said. Those brain cells are not recoverable.
“In stroke, we say, ‘time is brain,’” she said. “We want to get you to that definitive treatment as quick as possible.”
In the three years since UF Health launched the mobile stroke treatment program, it has reached more than one million residents in the three communities, she said.
From the point of patient contact, the unit is able to obtain lab results in three minutes, complete a CT scan in five minutes, provide clot-busting medication in 14 minutes, and get the patient into the hospital for a mechanical thrombectomy (clot removal) in 55 minutes, Davis said.
The 55-minute time frame for the thrombectomy is “wildly fast because [the] American Heart Association wants that to happen within 90 minutes of hospital arrival,” she said.
Patients treated on the mobile stroke treatment unit are more often discharged directly home instead of to a rehab facility. Hospital stays are shorter by an average of two days, and mortality is reduced by 45 percent, Davis said.
Council member Lew Crampton took note of the 45 percent reduction in mortality for patients treated by the mobile stroke unit. It would represent a great leap forward in emergency response in Palm Beach, which has an older population.
“In this town, that’s saying a lot,” he said. “I think it’s fantastic.”
“It’s absolutely amazing,” council member Nicki McDonald said. “Thank you to everybody who is making it possible.”
The council’s vote of conceptual approval was 4-0, with member Julie Araskog absent.
Baker said he’ll be back before the council with an update in October and expects to seek final approval in November or December.
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