(Cleveland, Ohio) “Oh, shit, you’re having a stroke.” Mike Wiertel will forever remember the words his co-worker uttered when he saw him paralyzed on his right side.
January 25, 2022. Mike Wiertel, 54, heads to downtown Cleveland, a city on Lake Erie, for a client meeting with his co-worker Skip.
“When I was about to leave, I thought I had put the keys in the ignition of the car, but my keys were still in my hand,” the man said in an interview with The Press. Confused, he tries again to put the key in the ignition, without success. His right side is paralyzed.
Skip asks him to stick out his tongue: it is deformed. Convinced that his colleague is having a stroke, he calls 911, which immediately dispatches a local ambulance, followed by a second specialized in treating strokes. It is the paramedics of the local ambulance who decide in which vehicle the patient will be transported.
Equipped with a scanner, the Cleveland Clinic’s specialized ambulance can make a diagnosis and begin treatment before a patient even arrives at the hospital, saving precious minutes that can sometimes mean the difference between life and death.
The mobile unit is staffed by an intensive care nurse, a paramedic, a medical assistant and a medical imaging technologist. Unlike the classic yellow ambulances, the blue, white and green specialized ambulance is clearly marked to treat strokes.
PHOTO ALICE GIRARD-BOSSÉ, THE PRESS
The Cleveland Clinic is one of the few medical facilities in the world that can count on such an ambulance.
A remote medical assessment
Specialized stroke ambulances were first introduced in 2008 in the Saarland region of Germany. Alberta is the only province in Canada with a specialized stroke ambulance. The vehicle was designed by a Quebec company (see second text).
In 2014, the Cleveland Clinic became the fourth medical facility in the world to implement such an ambulance and the first in the United States to use it on patients.
PHOTO ALICE GIRARD-BOSSÉ, THE PRESS
As soon as they arrive in the vehicle, patients are seen by a doctor via videoconference, who assesses the seriousness of the situation.
As soon as he was on the stretcher, Mike Wiertel was put in touch by videoconference with a doctor at the Cleveland Clinic thanks to a screen fixed to the ceiling.
“We check for difficulty speaking, weakness or paralysis on one side of the body, and visual changes such as vision loss or double vision,” explains Dr.D Sidonie Ibrikji, vascular neurologist, who remotely assesses and treats patients in the mobile unit.
PHOTO ALICE GIRARD-BOSSÉ, THE PRESS
The DD Sidonie Ibrikji, vascular neurologist
“I was really scared,” says Mike Wiertel. “I could hear everyone talking, but I couldn’t answer.” He tries as best he can to make himself understood by making signs with his left hand, which is still functional.
After the evaluation, Mike Wiertel is directed to the CT scanner (CT scan) in the back of the ambulance. This scan is essential to distinguish a stroke due to a clot from a stroke caused by a hemorrhage, since treatments vary depending on the cause.
Two types of stroke
There are two types of stroke: ischemic strokes, which are caused by a blockage in an artery in the brain, often due to a blood clot, and hemorrhagic strokes, which result from a ruptured blood vessel in the brain. Ischemic strokes are usually treated with medications to dissolve the clots, while hemorrhagic strokes often require interventions to control the bleeding, such as surgery or medications to reduce pressure inside the brain.
Treatment in the ambulance
PHOTO ALICE GIRARD-BOSSÉ, THE PRESS
In just a few minutes, the doctor can make a remote diagnosis.
Within minutes, images of Mike Wiertel’s brain appear on the monitor in the back of the ambulance. He is not hemorrhaging in the brain: the stroke is probably caused by a clot blocking blood flow.
The team administers intravenous thrombolysis to dissolve the clot. To be effective, this treatment must be carried out within four and a half hours of the onset of the stroke.
On the way to the hospital, Mike Wiertel regained his speech. “Hey, guys, I think it worked,” he recalled telling the medical team. He was also able to move the right side of his body again.
Mike Wiertel underwent various tests upon arrival at the hospital and remained hospitalized for three days before being discharged. He showed no after-effects from the event.
PHOTO ALICE GIRARD-BOSSÉ, THE PRESS
Stroke victim Mike Wiertel was taken to the Cleveland Clinic’s mobile unit.
If it wasn’t for the stroke ambulance, I might not even be here. It made all the difference. I’m the luckiest person in the world.
Mike Wiertel, Cleveland Clinic stroke patient
Increasingly younger patients
Since its launch in July 2014, the Cleveland Clinic ambulance has transported 2,600 stroke patients and now serves 13 municipalities in Northeast Ohio.
Getting the ambulance up and running was a challenge. The Cleveland Clinic invested more than $1 million to build its modern ambulance, a tall order in the United States, where hospitals “have to fund their own emergency vehicles,” says Dr.r Shazam Hussain. At the same time, a team of 25 health professionals had to be recruited to ensure rotations in the mobile unit.
The ambulance operates daily from 8 a.m. to 8 p.m. “That’s when we get the most calls for strokes,” says nurse and mobile stroke unit coordinator Justin Pearce. Some days can be very quiet, with no calls at all, while others can have a dozen or so.
Patients aren’t limited to the elderly. The team is seeing a growing number of young people. “It’s lifestyle. We’re starting to see young people with high blood pressure, a risk factor for stroke, who aren’t being treated and aren’t being diagnosed,” Pearce says. The youngest patient was 19.
Another case that stood out to the team was a young man in his mid-twenties who suffered a massive stroke at his wedding reception. “He was dancing and suddenly he couldn’t express himself. Then he started to feel weak on one side of his body and collapsed on the dance floor,” recalls Dr.D Ibrikji.
The young patient received treatment right in the ambulance. “The next day, I couldn’t believe how much he had improved compared to the condition he was in the day before,” says Dr.D Ibrikji.
“A considerable advantage”
The team administered intravenous thrombolysis to dissolve blood clots to more than 300 patients and transported 161 patients with brain hemorrhages.
PHOTO ALICE GIRARD-BOSSÉ, THE PRESS
The Dr Shazam Hussain, director of the Cerebrovascular Center at the Cleveland Clinic Neurological Institute
Compared to someone arriving at the emergency room on their own, we save about 45 minutes by treating them directly in our ambulance. Given that every minute of a stroke results in the loss of about 2 million brain cells, this is a significant advantage.
The Dr Shazam Hussain, director of the Cerebrovascular Center at the Cleveland Clinic Neurological Institute
Studies1 compared the condition of patients transported by a local ambulance with that of patients transported by a specialized ambulance. Three months after their stroke, patients treated by the specialized ambulance had fewer after-effects, says Dr.D Ibrikji.
1. A study was published in the medical journal The New England Journal of Medicine in September 2021.
Can all Americans afford this specialized ambulance?
If the emergency services dispatcher judges that a person needs the specialized ambulance, he will send it, regardless of the patient’s financial means. The law Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals in the United States to provide emergency care to anyone who presents to the emergency room, regardless of their ability to pay. They must evaluate and stabilize the patient before discussing financial issues.
Learn more
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- 1.9 million
- Number of brain cells that die every minute after a stroke
Heart and Stroke Foundation
- 37 minutes
- In 2021, Cleveland Clinic’s mobile unit was able to administer intravenous thrombolysis an average of 37 minutes faster than if the patient had otherwise been transported to an emergency department.
Cleveland Clinic