This is NOT my video. I found it randomly while looking for something else on Facebook. What I was looking for is not important, but this video is and is funny as well.
It sums up my thoughts on so called “Stroke Ambulances”. Especially as used in the pilot programs in various urban areas. What a waste of money.
I was at a presentation some months ago where a very earnest nurse was explaining all of the benefits of stroke ambulances. The problem was that she didn’t mention any of the disadvantages or even the cost factor and Return on Investment. She told us that a specialized ambulance would cost about $150,00.00. I was very polite in my critique, other than the opening where I said “Welcome to Shark Tank.”
Her cost estimates were wildly optimistic, not limited to the bare vehicle cost. Which would be much closer to $250.000.00 for the type of unit needed. Plus the $400,00.00 cost for the CT unit. Not to mention that the response radius in at least one of the pilot systems is less than one square mile from the hospital. Oh, then if the patient rules out for tPA, the stroke ambulance stays on scene and calls for a regular 9-1-1 ambulance.
I kid you not.
Anyway, here is the video, courtesy of Jason Kodat MD.
Since this isn’t a Youtube video, you’ll have to click on the link. Be sure to set sub titles to “On”.
Yep, that one is on the money… PP has one that she manages for UC Davis Children’s that is a neonatal rig, it was right at $300,000.00 but it actually runs all over Northern California.
Neonatal rigs are expensive, but they are highly specialized and have a much wider response area. The big pediatric hospital nearest to me runs two behemoth units. Medium duty chassis with four door cabs. The EMS personnel that comprise the crew are there mostly to make it “legal” under the state regulations. They seem pretty busy, and do both incoming and outgoing transports. These stroke ambulances are so highly specialized that I just don’t see how they make sense. Over the past couple of years, I’ve heard from a number of EM physicians skeptical comments about the entire approach to stroke treatment in the ED. One doctor recently told me that less than 5% of Stroke patients at her ED get tPA and that personally, she’s only given it once.
5% seems absurdly low. I would bet their hospital has established criteria more strict than most. Anybody with a LAMS score if 4 or higher should be getting it as a matter of course, barring any absolute contraindications. And then transferred to a Comprehensive Stroke Center, because mechanical clot retrieval is the sh!t.
It seemed low to me as well, but in talking to ED doctors from several different hospitals, they are as a group underwhelmed with the evidence supporting tPa in Stroke. Clot retrieval is pretty amazing technology, and I’m hopeful it will become more widespread in the future. I’d much rather see resources (money) put into expanding that capability.