Magen David Adom ambulance 311.
(photo credit: REUTERS)
Magen David Adom is examining the possibility of eventually adopting new German
technology that installs a mobile computerized tomograhy (CT) scan in ambulances
that can determine whether a patient with symptoms of an ischemic stroke has had
one, and dissolve clots in the brain before they cause damage.
training department director told The Jerusalem Post that he had transferred the
new study to relevant MDA experts.
A preliminary study by neurologists
from hospitals in Homburg and Nuremberg in Germany about out-of-hospital
treatment of stroke was recently published in the open-access PLoS (Public
Library of Science) One journal. If specially trained doctors see on the CT scan
in the ambulance that the patient with stroke symptoms is having or about to
have a ischemic stroke in which a clot is blocking blood supply to the train,
and on-the-spot blood tests confirm it, they can inject a lifesaving drug called
rTPA (tissue plasminogen activator) on the spot and can prevent stroke
The CT is needed so that the doctors can be sure he is not having
a hemorrhagic stroke; in that case, injecting rTPA that makes the blood flow
smoothly could worsen the situation and even kill him. Former prime minister
Ariel Sharon, who has been in a deep coma and suffering from lowerbrain death
for the past five years, had two strokes, the first ischemic and the second
A few thousand Israelis suffer strokes or TIAs (transient
ischemic attacks, which often proceed full-fledged strokes) each year. Among the
easily recognizable warning signs are being unable to smile, speak or shake
someone’s hand. Stroke symptoms include numbness or weakness of the face, arm or
leg, especially on one side of the body; confusion, trouble speaking or
understanding; trouble seeing in one or both eyes; trouble walking, dizziness,
loss of balance or coordination; or severe headache with no known cause – all of
them appearing suddenly.
Many people with symptoms delay going to the
hospital, thinking that it is not really a stroke and that the symptoms will
But if they are not treated within three hours of onset, the stroke
– and disability or death – are almost inevitable.
Prof. Jose Cohen, one
of the country’s leading stroke experts who treated Sharon in the stroke unit at
Hadassah University Medical Center in Jerusalem’s Ein Kerem, told the Post
the idea of treating stroke victims immediately at home or wherever they are is
The German model consisted of a “mobile stroke unit
consisting of an ambulance equipped with a CT scan, a point-of-care laboratory
system for complete stroke laboratory workup and telemedicine capabilities for
contact with hospital experts.”
If it is an ischemic stroke, rTPA
thrombolysis can be performed.
The German neurologists concluded that
their preliminary study “proves the feasibility of guideline-adherent,
etiology-specific and causal treatment of” acute stroke directly at the
“More than 90 percent of Israeli stroke patients come
late to the hospital, and this delay is the main limitation of stroke
therapies,” Cohen said. “I always fantasized having an ambulance with CT that
may allow giving rTPA on the field after a brief, basic triage.”
that “time is brain” is a largely precise saying. “Clinical outcomes have been
shown to deteriorate the longer treatment is delayed.”
Every minute you
wait, hoping your symptoms will go away, you lose almost two million brain
cells, Cohen said. The brain has 22 billion neurons and in a typical stroke, 120
million neurons and 830 billion synapses are completely lost. In other words,
compared to the normal rate of neuron loss in ageing brain, the ischemic brain
ages 3.6 years each hour without treatment.
He warned that trying to call
your family doctor, son, rabbi or even neurologist is a “waste of time” in these
circumstances. “If you are suffering a stroke, you need emergency assistance.
You need urgent transfer to the hospital, rapid assessment of a stroke
specialist, a head CT and start injection of the anti-clot drug
“Imagine this can be done in a special ambulance at the front of
your house,” Cohen continued.
The loss of brain cells could be only be
arrested if treatment is dispensed immediately, especially if the anti-clot drug
is administered within three hours of a stroke. Twenty people from each 100 that
suffer a stroke die in the hospital, mainly due to delay in treatment.