Patient Stories

Mobile Stroke Unit Delivers Timely, World-Class Care for Local College Student

Jun. 17, 2021

Cincinnati’s mobile stroke unit, guided by UC Health experts, saves more lives, even in rare cases of unexpected stroke in young adults.

Saturday mornings are for sleeping in when it comes to most college students. Normally, 20-year-old Devyn would be snoozing like the best of them, but this Saturday was different — he was home from school and had picked up a shift working with his stepbrother, Cameron. Devyn drove to the warehouse where they began their 8 a.m. shift like any other, until Devyn began to feel strange.

“I was lightheaded, dizzy and started to feel out of it in a dazed way,” said Devyn. “My brother noticed my face was drooping and when he asked me what was wrong, I was too confused to respond.” 

Devyn could not feel the left side of his body and fell to the floor. Cameron dialed 911 and called their mother.

“That morning was a blur for all of us,” said Sarah, Devyn’s mother. “I spoke with a paramedic who was on the scene — he told me he was calling a Mobile Stroke Unit based on Devyn’s symptoms. When I heard that it was so hard to believe because Devyn had just turned 20. How could someone so young and healthy be having a stroke?”

Devyn’s father, Matt, had just started fishing in Felicity, Ohio, when he got the call that his son was having a stroke. “I get terrible reception out there — and I heard Cameron say Devyn was going to the hospital, but then my phone was cutting out. My mind was racing the whole time I drove back, wondering what was going on, was my son going to be OK?” said Matt. “It was the worst moment of my life.”

A stroke occurs when a blood clot blocks a blood vessel in the brain (called an ischemic stroke) or ruptures (called a hemorrhagic stroke). About 85% of all strokes in the U.S. are ischemic strokes. When this happens, it’s only a matter of minutes before brain cells begin to die and permanent damage occurs.

The paramedic on scene called the UC Health Mobile Stroke Unit, and his decision to hand over care was an integral link in the following chain of events for Devyn.

Mobile Stroke Care – A First in Greater Cincinnati

UC Health launched the region’s first and only Mobile Stroke Unit in August 2020. The Mobile Stroke Unit includes a critical care paramedic and registered nurse, an EMT and a CT technologist on board with a stroke team physician available through a telemedicine video link.

This expertise combined with the resources of our internationally recognized stroke team helps provide patients with the best possible care when a fast response is critical.

“I was the critical care nurse on the Mobile Stroke Unit that day,” said Sharon Walsh-Hart, clinical program developer of UC Health Air Care & Mobile Care at UC Medical Center. “As soon as Devyn was in our care, I started going through all my differentials — could this be a hemiplegic migraine, is this Bell’s palsy, does he have a history of clotting disorders in his family? By looking at him, though, it was obvious he was having a stroke.”

The Mobile Stroke Unit comes equipped with a computed tomography (CT) scanner to help diagnose a stroke as well as the ability to begin treatment before the patient arrives at the hospital.

Devyn had a CT scan and blood and glucose tests, and was started on IV fluids. “I never had any health issues in my life and there I was in the back of this ambulance being assessed for a stroke — it just didn’t make sense to me,” said Devyn.

On the Mobile Stroke Unit, the CT scans are sent through a private Wi-Fi system to UC Health to be examined. A stroke specialist evaluates the patient via a telemedicine video call, seeing and speaking to the patient — all while in route to the hospital. The goal is to find out what type of stroke is happening, and where, to determine whether the patient is a candidate for a revolutionary clot-busting medication called tPA.

Clot-Busting Medication, Leading-Edge Treatment

The only FDA-approved treatment for ischemic stroke is Alteplase IV r-tPA, also known as tissue plasminogen activator (tPA). It works by dissolving the clot and improving blood flow. If administered within three hours (and up to four-and-a-half hours in certain eligible patients), tPA may improve the chances of recovering from a stroke.

UC Health physicians and researchers paved the way for tPA. In order to become an approved stroke treatment, clinical trials were run to prove efficacy. More than 75% of the patients in the pilot three-center tPA trial were treated at UC Health and associated community hospitals. 

These developments changed stroke from an untreatable human disease to an eminently treatable one, and throughout the world, prehospital and hospital treatment of all types of acute stroke began to change.

The stroke team physician reviewed the CT scan taken in the Mobile Stroke Unit and evaluated Devyn using the video monitor. To save precious time, Sharon started the tPA infusion in the Mobile Stroke Unit before they arrived at the Emergency Department.

The faster tPA is administered, the faster the blood clot will dissolve and open up the vessel to allow blood to flow back into the brain, preventing that part of the brain from dying.

“When it comes to stroke, we know every minute really does count,” said Christopher T. Richards, MD, medical director of the UC Health Mobile Stroke Program and assistant professor in the Department of Emergency Medicine at the University of Cincinnati College of Medicine. “The Mobile Stroke Unit allows us to get critical information in the prehospital setting. This helps in many ways: First, it allows us to quickly treat patients who are experiencing stroke. Additionally, if we diagnose a severe stroke that might benefit from a procedure to remove the blockage, the Mobile Stroke Unit will transport directly to a stroke center hospital that can treat complex stroke cases, which can shorten the patient’s time to treatment.” 

“If we have the patient’s scans and tests in advance and we diagnose a ‘large vessel occlusion,’ sometimes those patients can go directly to the endovascular suite to have the blockage removed, even bypassing the Emergency Department,” said Dr. Richards.

Thankfully, tPA was already working wonders on Devyn’s clot. When he was initially picked up, Devyn was experiencing a severe stroke; when the mobile stroke team handed him over to the UC Medical Center Emergency Department, his stroke had lowered to the mild range.

“Devyn’s case is like the Swiss cheese model of patient safety, except instead of all the holes lining up for a bad outcome, for Devyn they lined up for a great outcome,” said Sharon. “He was at work early on a Saturday morning; his stepbrother called 911 immediately; the paramedic knew to dispatch the Mobile Stroke Unit. It might have shaved 20 minutes off Devyn’s treatment time, but for a stroke patient, 20 minutes can equal millions of lost brain cells.”

Finding the Cause

“When Devyn came in, I was the neurointerventionalist on call. We were notified that a patient was on his way, had a blockage, and was receiving tPA,” said Aaron W. Grossman, MD, PhD, neurologist and neurointerventionalist at the UC Gardner Neuroscience Institute and associate professor in the Department of Neurology & Rehabilitation Medicine at the UC College of Medicine. “Our neurointerventional team was on standby in case we needed to go in and remove a blockage upon his arrival.”

Devyn’s condition had improved so much with the tPA alone that he didn’t need a thrombectomy. Instead, he was admitted to the UC Medical Center Neuroscience Intensive Care Unit (NSICU), which is the largest and most technologically advanced neuroscience ICU in the region. Patients with brain and spinal cord injuries are provided with around-the-clock care by neurosurgeons, neurointensivists, neuroradiologists, nurses, pharmacists, therapists, social workers and dietitians — all specialized in treating neurological disorders using state-of-the-art neuromonitoring.

“Once Devyn was in our NSICU, we began looking for causes of stroke in such a young person,” said Dr. Grossman. “We look for blood clot disorders and structural abnormalities of the heart — and we found that Devyn had a patent foramen ovale (PFO), which is a hole in the heart that didn’t close the way it should have after birth.”

During fetal development, a small flap-like opening (the foramen ovale) is usually located in the wall of tissue between the right and left upper chambers of the heart (atrium). This hole allows blood to bypass the fetal lungs, which cannot work until they are exposed to air. It normally closes within a few months after birth and remains completely sealed for about 75% of us. If it does not close, it’s called a patent foramen ovale.

According to the American Heart Association, approximately 25% of the population has a PFO. The vast majority of these people do not experience adverse symptoms — or know they have it — even though blood is leaking from the right atrium to the left. The larger the hole, however, the more likely there are to be symptoms, and problems arise when blood clots form.

PFO does not cause strokes; they make a dangerous bridge that can allow a blood clot to pass from the right to the left side of the heart, entering the circulation system. If the clot travels to the brain, the chances of a stroke are high.  

Devyn underwent surgery to close the PFO and reduce the chances of having another stroke in his lifetime.

Life After Stroke

A stroke causes tissue damage in areas of the brain that are linked to speech, language, and movement. The amount of damaged tissue determines whether these capabilities are affected and for how long — whether temporary or long-term.

Devyn’s quick care saved him from enduring impaired speech or motor issues for the rest of his life. The weeks following his stroke weren’t easy, however.

“When I was discharged from the hospital, I had a new primary care provider, cardiologist, electrophysiologist, hematologist and neurologist,” said Devyn. “I had physical, occupational and speech therapy through UC Health. My speech took the longest because the left side of my face didn’t improve as quickly as my balance and vision, but after about two months of speech therapy I was back to normal.”

A litany of appointments can be overwhelming, but one person in particular helped Devyn and his family through the journey. “Dr. Grossman went out of his way to make Devyn feel like a VIP every time we were at UC Health,” said Sarah. “Some doctors wanted to treat Devyn as a regular stroke patient who is 60+ years of age, but he’s not a regular stroke patient — he’s only 20 years old. Dr. Grossman thought out of the box in regard to Devyn and what was best for his unique situation.”

For example, stroke survivors are usually advised to take blood thinners for the rest of their lives. Dr. Grossman knew that course of treatment would negatively affect Devyn and instead advised Devyn take baby aspirin.

Making Every Minute Count

Devyn attends Syracuse University, pursuing a degree in communication and music journalism. After his stroke, the school wanted him to go on medical leave, but Devyn pushed back.

“I’d already been in school long enough to where if I took medical leave, all the work I’d done would be gone and it would end up taking me longer to graduate,” said Devyn.

He advocated for himself by contacting all of his professors to make sure they supported him coming back, which they did. Devyn was able to finish the semester online and even made dean’s list.

“Since I’ve been in college, I’ve had straight As, but that semester will always be one that stands out,” said Devyn. “The fact I was able to do the work and keep my grades up after having a severe stroke was kind of amazing.”

Devyn’s professors made a point to contact Sarah once a week to see how he was doing. One assignment, a paper Devyn wrote about preexisting conditions, brought one professor to tears.

Music is Devyn’s passion; he works for a campus publication that discusses all things hip-hop and hopes to work in the music industry someday. In his free time, Devyn and his friends make music with their own recording equipment.

Time is Brain

“Sharon told me she’s never seen tPA work as well as it did for Devyn. She watched his symptoms melt away almost immediately and she told me how impressed and relieved she felt,” said Sarah. “I want more awareness to be spread about the Mobile Stroke Unit because it absolutely saved Devyn’s life.” 

As illustrated in Devyn’s case, it is critically important to recognize a stroke as soon as it happens. The faster the response, the better the chance for recovery. That is why in 1993, the UC Health Stroke team developed a simplified stroke screening that led to the F.A.S.T. Scale — Face, Arm, Speech, Time — now the worldwide standard to help identify a stroke.

  • “F” stands for facial drooping or numbness in the face.
  • “A” stands for arm (or leg) weakness or numbness.
  • “S” stands for slurred speech or difficulty speaking.
  • “T” stands for time to call 911.

“Devyn was our third patient to receive tPA in the Mobile Stroke Unit, and certainly our youngest,” said Sharon. “I doubt we will ever break that record, but if it had to be broken, that’s exactly what why we are here.”  

“This kind of success is what makes every bad day at work worth it,” said Sharon. “I’m proud to work for UC Health Air Care & Mobile Care. We provide a tremendous service to the area; we’re at the forefront of mobile stroke care, and I hope we’re able to provide further coverage in the future.”