SR 08-08-2017 3O1 of 4
To: Mayor and City Council
From: Bill Walker, Fire Chief, Fire Department
Subject: Memorandum of Understanding with University of California Regents for
Emergency Stroke Transport Services
Recommended Action
Staff recommends that the City Council authorize the City Manager to negotiate and
execute a Memorandum of Understanding with the Regents of the University of
California, on behalf of the UCLA Health System and the David Geffen School of
Medicine at UCLA, Department of Neurology, a California based public research
university, for Emergency Stroke Transport Services.
Executive Summary
On June 20, 2017, the Los Angeles County Board of Supervisors voted to fund a mobile
stroke unit pilot program in Los Angeles County. The University of California Los
Angeles (UCLA) Mobile Stroke Unit, called the Gluck Stroke Rescue Program, has
asked the Santa Monica Fire Department (SMFD) to collaborate on a mobile stroke unit
pilot program to begin implementation in August 2017. Stroke disease is the number
one cause of disability among adults and is the fifth leading cause of death among
adults in the United States. This pilot would deploy a dedicated specialized ambulance
provided by UCLA and a medical team devoted to treating stroke patients. The pilot will
take place over a two-year period, with a potential one-year extension, to evaluate the
effectiveness in reducing deaths and disability caused by stroke. The SMFD has
agreed to participate pending Council approval. SMFD has a long-standing relationship
with UCLA and the department has a history of implementing innovative programs. The
pilot program has no direct financial impact, all program costs would be reimbursed by
UCLA.
Ci ty Council Report
City Council Meeting : August 8, 2017
Agenda Item: 3.O
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Background
A mobile stroke unit is a type of ambulance equipped with a portable computed
tomography (CT) scanner and clot busting drugs which allow doctors to diagnose and
treat strokes in the field. By restoring blood flow to the brain before a patient arrives at
the hospital, mobile stroke units can save lives and prevent long-term brain damage and
disability associated with strokes. The mobile stroke unit team is comprised of a Stroke
Neurologist, Critical Care Nurse, CT Technician, and a Santa Monica Fire Department
Paramedic.
Definitive treatments for acute stroke can only be started after a brain CT is done and
shows the type of stroke suffered. Mobile stroke units bring the hospital to the patient
allowing for timely treatment as “time is brain”. Treatment can be started 30-60 minutes
faster resulting in substantially improved patient outcomes.
A mobile stroke unit carries a CT scanner on board so that, once its identified a patient
with clinical signs of an acute ischemic stroke in the field and confirms that the timing of
the stroke onset suggests eligibility for tPA treatment, a CT scan can immediately be run
on site to finalize tPA eligibility. The mobile stroke unit staff can then begin infusing the
drug in the ambulance on the way directly to a comprehensive stroke center.
In 2011, the world’s first active mobile stroke unit was deployed in Germany. Since
then, mobile stroke units have expanded across the globe. While there are 14 mobile
stroke units operating with positive results in states across the United States, no mobile
stroke unit is yet operating in the State of California.
UCLA and the City of Santa Monica Fire Department will be collaborating to implement
the first mobile stroke unit in California. Not only will this be the first mobile stroke unit
in the state but thanks to the generous support of Arline and Henry Gluck, it will be the
first in the nation to be supported by a public-private partnership. The County Board of
Supervisors’ motion directs $1.46 million to expand the mobile stroke unit pilot program
run by UCLA Health. The funding comes from the County of Los Angeles Measure B, a
parcel tax funding source dedicated to supporting emergency and trauma services.
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Early data collected shows that initiating care of an acute ischemic stroke patient in a
mobile stroke unit shaves precious minutes off the time it takes to start thrombolytic
therapy with tissue plasminogen activator (tPA) compared with that at a hospital, and
findings from preliminary analyses suggest better functional outcomes for these
patients.
Discussion
The Santa Monica Fire Department will provide the paramedic to join the team to
provide emergency transport services. Participation in the pilot program does not
require additional Fire Department resources or personnel. An existing paramedic on
an overtime assignment will fill the pilot program position. The SMFD paramedic will be
responsible for driving the dedicated mobile stroke unit provided by UCLA and no
additional licenses are required.
There will be no delay in treatment or transport and no change in emergency response
protocols as a result of the pilot. All calls for service will follow the Fire Department’s
normal call protocol during the term of the MOU but a potential stroke will be augmented
with a response by the mobile stroke unit to provide rapid in the field response for acute
stroke treatment.
The Fire Department will be part of the team collecting program data to assess the
clinical efficacy and cost effectiveness of the mobile unit. The Fire Department will
return to Council at the end of the pilot program to report on the program’s
accomplishments.
Financial Impacts and Budget Actions
There is no immediate financial impact or budget action necessary as a result of
recommended action. Staff will return to Council if specific budget actions are required
in the future. The pilot program costs to fund existing staff on an overtime assignment
will be approximately $180,000 annually. All program costs associated with the mobile
stroke unit pilot program will be reimbursed by UCLA.
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Prepared By: Terese Toomey, Principal Administrative Analyst
Approved Forwarded to Council
REFERENCE:
AGREEMENT NO. 10530
(CCS)