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Stroke Ambulances - The Future Standard in Stroke Care?

Canada's first trial of an advanced Stroke Ambulance in Edmonton could signal a new era of significantly improved standard of care of ambulance-level stroke care in this country. Equipped with a mobile CT scanner and an internet link to the on-call neurologist in the hospital, the new stroke ambulance has the potential to dramatically improve patient outcomes and could become the new standard of care of emergency ambulance response to a call where symptoms reported could be those of a stroke. Why are we so excited about Canada's first highly-specialized Stroke Ambulance and why do we believe that other health jurisdictions in the country should follow?

A stroke occurs when blood flow to the brain is cut off, leading to the death of the affected brain cells. While all strokes are serious matters, they do not all result in debilitating injuries. If identified and dealt with promptly, a stroke can often be contained to only have mild consequences. Doctors estimate that over 100 million brain cells die each hour, so rapid diagnosis and treatment is critical to a patient's chances of making a successful recovery.

To understand why they say, "time is brain", it is important to understand that strokes arise from two primary causes, and are classified and treated accordingly:

  1. ischemic strokes are caused by a blood clot restricting blood flow in the brain,
  2. hemorrhagic strokes are caused by a burst blood vessel causing uncontrolled bleeding in the brain.

According to the Canada Heart and Stroke Foundation, ischemic strokes make up approximately 80% of cases, and hemorrhagic strokes make up the remaining 20%. The fundamental difference between the causes of the two types of stroke results in completely different treatment protocols. For example, patients suffering ischemic strokes are commonly administered medication known as tPAs (tissue plasminogen activators) that actively break down blood clots, and the sooner they can be administered the better the chances are of recovery. Importantly, the patient must receive these tPAs within the first three hours of the onset of the stroke symptoms for medication to have any meaningful effect. The tricky issue in the timing is that before the treatment can be administered, it is necessary to determine the type of stroke a person is suffering. If tPAs are administered to a person suffering a hemorrhagic stroke, the medication can exacerbate the already damaging bleeding going on in the brain and can lead to devastating consequences.

With the key technological developments in the Stroke Ambulance of an in-ambulance mobile CT scan and an internet link radiologist and neurologist, the CT scan can be conducted on the spot and immediately sent for review by an expert radiologist, identifying the type of stroke far sooner than possible before. In approximately four out of five cases, it will be the more common ischemic stroke, allowing the vital tPAs to be administered much sooner, potentially by hours for rural patients. This can be the difference between a mild or serious stroke, a short or lengthy recovery, and a small or significant cost to the health care system.

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