The Evolution of Prehospital Stroke Care
For decades, the mantra in stroke neurology has been ‘time is brain.’ The introduction of Mobile Stroke Units (MSUs)—specialized ambulances equipped with a computed tomography (CT) scanner, point-of-care laboratory testing, and a specialized team—has revolutionized the ‘Golden Hour’ of stroke care. By bringing the diagnostic and therapeutic capabilities of an emergency department directly to the patient’s doorstep, MSUs have significantly reduced the time to thrombolysis and improved functional outcomes. However, a critical logistical challenge remains: the staffing of these units. Historically, many MSU programs have relied on having a neurologist physically present on the vehicle. While this ensures immediate expertise, it is a resource-intensive model that consumes a specialist’s entire shift for a relatively small number of cases. Telemedicine has emerged as a potential alternative, yet until now, the two models had not been compared in a head-to-head randomized trial. The MSU-TELEMED trial, recently published in NEJM Evidence, provides the first high-level evidence to guide this choice.
