title: Establishing the first mobile stroke unit in the United States.
abstract: OBJECTIVE
  Recently, the Mobile Stroke Unit (MSU) concept was introduced in Germany demonstrating prehospital treatment of more patients within the first hour of symptom onset. However, the details and complexities of establishing such a program in the United States are unknown. We describe the steps involved in setting up the first MSU in the United States.
  
  
  METHODS
  Implementation included establishing leadership, fund-raising, purchase and build-out, knitting a collaborative consortium of community stakeholders, writing protocols to ensure accountability, radiation safety, purchasing supplies, licensing, insurance, establishing a base station, developing a communication plan with city Emergency Medical Services, Emergency Medical Service training, staffing, and designing a research protocol.
  
  
  RESULTS
  The MSU was introduced after ≈1 year of preparation. Major obstacles to establishing the MSU were primarily obtaining funding, licensure, documenting radiation safety protocols, and establishing a smooth communication system with Emergency Medical Services. During an 8 week run-in phase, ≈2 patients were treated with recombinant tissue-type plasminogen activator per week, one-third within 60 minutes of symptom onset, with no complications. A randomized study to determine clinical outcomes, telemedicine reliability and accuracy, and cost effectiveness was formulated and has begun.
  
  
  CONCLUSIONS
  The first MSU in the United States has been introduced in Houston, TX. The steps needed to accomplish this are described.
authors.affiliation: From the Department of Neurology, University of Texas-Houston Medical School (S.A.P., R.B., T.-C.W., E.A.N., K.J., D.P.); Frazer Ltd, Houston, TX (L.R.); Department of Emergency Medicine, City of Houston Emergency Medical Services, Texas (D.P.); and Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.).
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Parker
authors.affiliation: From the Department of Neurology, University of Texas-Houston Medical School (S.A.P., R.B., T.-C.W., E.A.N., K.J., D.P.); Frazer Ltd, Houston, TX (L.R.); Department of Emergency Medicine, City of Houston Emergency Medical Services, Texas (D.P.); and Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.).
authors.forename: Ritvij
authors.initials: R
authors.lastname: Bowry
authors.affiliation: From the Department of Neurology, University of Texas-Houston Medical School (S.A.P., R.B., T.-C.W., E.A.N., K.J., D.P.); Frazer Ltd, Houston, TX (L.R.); Department of Emergency Medicine, City of Houston Emergency Medical Services, Texas (D.P.); and Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.).
authors.forename: Tzu-Ching
authors.initials: TC
authors.lastname: Wu
authors.affiliation: From the Department of Neurology, University of Texas-Houston Medical School (S.A.P., R.B., T.-C.W., E.A.N., K.J., D.P.); Frazer Ltd, Houston, TX (L.R.); Department of Emergency Medicine, City of Houston Emergency Medical Services, Texas (D.P.); and Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.).
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Noser
authors.affiliation: From the Department of Neurology, University of Texas-Houston Medical School (S.A.P., R.B., T.-C.W., E.A.N., K.J., D.P.); Frazer Ltd, Houston, TX (L.R.); Department of Emergency Medicine, City of Houston Emergency Medical Services, Texas (D.P.); and Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.).
authors.forename: Kamilah
authors.initials: K
authors.lastname: Jackson
authors.affiliation: From the Department of Neurology, University of Texas-Houston Medical School (S.A.P., R.B., T.-C.W., E.A.N., K.J., D.P.); Frazer Ltd, Houston, TX (L.R.); Department of Emergency Medicine, City of Houston Emergency Medical Services, Texas (D.P.); and Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.).
authors.forename: Laura
authors.initials: L
authors.lastname: Richardson
authors.affiliation: From the Department of Neurology, University of Texas-Houston Medical School (S.A.P., R.B., T.-C.W., E.A.N., K.J., D.P.); Frazer Ltd, Houston, TX (L.R.); Department of Emergency Medicine, City of Houston Emergency Medical Services, Texas (D.P.); and Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.).
authors.forename: David
authors.initials: D
authors.lastname: Persse
authors.affiliation: From the Department of Neurology, University of Texas-Houston Medical School (S.A.P., R.B., T.-C.W., E.A.N., K.J., D.P.); Frazer Ltd, Houston, TX (L.R.); Department of Emergency Medicine, City of Houston Emergency Medical Services, Texas (D.P.); and Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.). James.c.grotta@uth.tmc.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
mesh_terms: D002017:Budgets; D003142:Communication; D003627:Data Interpretation, Statistical; D004632:Emergency Medical Services / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000628:therapy; D008952:Mobile Health Units / Q000191:economics / Q000458:organization & administration*; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D013781:Texas; D015912:Thrombolytic Therapy / Q000379:methods; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014481:United States; D000078329:Workforce
chemical_list: D010959:Tissue Plasminogen Activator
keywords: EMS; acute stroke; ambulance; prehospital; thrombolysis