CLEVELAND, Ohio -- Nothing - not even a stroke - was going to stop Darren Smith from meeting Gene Simmons of Kiss.Gene Simmons of Kiss.
Smith, 47, clung to his resolve even though he felt strange as he stood in line to see his lifelong idol at the Rock & Roll Hall of Fame in April.
He kept dropping the bag he held in his left hand. His left arm hung like dead weight. During a trip to the bathroom, he looked in the bathroom mirror and saw his mouth drooping on one side. He struggled to buckle his belt.
Smith's best friend, Bob Nash, who had driven with him from their homes near Detroit, asked Rock Hall staffers to call 911. The Cleveland Clinic's mobile stroke treatment unit, a special ambulance that delivers fast care to stroke patients, arrived quickly.
But Smith, a Kiss collector who has met Simmons multiple times, refused to leave the Gene Simmons Vault Experience. He had paid $2,000 for the Vault, which included one-on-one time with Simmons, a 10-CD collection, a Simmons action figure, a coffee table photo book and a hand-selected personal gift from the musician's archive.
If Smith left, he'd get nada.
When Simmons learned about the medical emergency, he found Smith and ordered him to get in the mobile stroke unit right away. "I couldn't say no to him," Smith recalled.
Reluctantly, Smith climbed into the ambulance - a decision that he credits with saving his life.
Fast treatment is critical
Time is brain, stroke specialists often say.
A stroke occurs when blood flow to the brain is interrupted, usually by a blood clot or brain bleed. The sooner a stroke patient is treated, the less likely it is that he or she will be disabled, said Dr. Andrew Russman, head of the Clinic's stroke program. Reduced disability, in turn, means less money and time spent on rehabilitation, and less time away from work.
The mobile stroke unit brings the emergency department to the patient wherever they are stricken. Launched in 2014, this single stroke unit serves 11 cities in Cuyahoga County and operates seven days a week.
The Clinic has the only stroke treatment unit in Northeast Ohio. Since inception, the unit has transported more than 1,000 patients, the Clinic said. It takes most stroke patients to the MetroHealth System, University Hospitals and the Clinic.
When the Rock Hall emergency call came, the EMS dispatcher sent a traditional ambulance as well as the stroke unit to the address. If Smith had not actually had a stroke, EMS would have taken him to a nearby hospital for treatment.
The stroke unit is outfitted with blood-testing equipment, a portable CT scanner that wirelessly transmits brain images to Clinic neuroradiologists and two-way videoconferencing technology connected to Clinic stroke specialists. The unit's critical care team also can administer tissue plasminogen activator (tPA), a blood clot-busting drug, intravenously when necessary.
Treatment begins
By the time Smith finally was persuaded to get into the stroke unit, he was paralyzed on his left side. His blood pressure was sky high. While en route to the Clinic, the stroke unit's four-person critical care team asked Smith to follow simple commands - to make a fist, raise an arm or remember his birthday -- to determine how much impairment already had occurred.
The CT scanner revealed that Smith had a type of stroke called an intracerebral hemorrhage, a bleed caused by the rupture of a small blood vessel in the brain.
The videoconferencing set-up linked the stroke unit's crew to Russman, who was at home. The doctor used a separate
to observe Smith and view his CT scans. Smith didn't need tPA, the clot-busting drug, which is used only on patients whose strokes are caused by a blocked blood vessel in the brain, Russman said.
The team worked to get Smith's blood pressure under control while Russman briefed the Clinic's neurological ICU on his condition. After arriving at the Clinic, Smith underwent surgery to remove the brain bleed.
"They were completely ready for him when he got there," Russman said. "We did so much for this guy. It made me feel really good about what I do."
Other care providers shared that sense of accomplishment.
"It is amazing," said nurse Joseph Kale, who is part of the critical-care team. "It's a great feeling. It's why I became a nurse, so I could save lives and make people better."
Stroke units spread
The Clinic's stroke unit was the second one in the country when it debuted four years ago. More than a dozen such units have been deployed in the United States since the first one was created in Houston in 2014, according to the American Heart Association.
In Ohio, the Toledo-area Mercy Life Flight Network Mobile Stroke Unit serves a five-county region. It completed 198 transports in 2017, a spokeswoman said.
As more mobile stroke units pop up, health care experts question whether they are worth the expense and whether they actually improve health outcomes.
New units cost between $800,000 and $1.2 million, plus operating costs. The Clinic spent about $1 million to buy its stroke unit, which costs $500,000 to $600,000 a year to operate.
The Clinic does not charge a transport fee for the mobile stroke unit, a spokeswoman said. Transportation in the unit is paid for by philanthropy and the Clinic; patients are billed only for medical services such as drugs and tests.
"While mobile stroke units seem like a good idea and there is genuine hope that they will improve outcomes for selected stroke patients, there is not yet any evidence that this is the case," Dr. Bryan Bledsoe, a professor of emergency medicine at the University of Las Vegas, wrote in the Journal of Emergency Medical Services. "They are expensive and financially non-sustainable."
But two studies presented at the American Stroke Association's International Stroke Conference in 2015 showed that mobile stroke units were saving critical minutes in the diagnosis and treatment of stroke patients. The studies looked at outcomes at the Clinic and in Houston.
The Clinic's statistics show that, since the mobile stroke unit hit the streets, stroke patients are receiving intravenous tPA seven minutes faster. Russman is taking part in a study, not yet published, that will compare 140 patients treated in a mobile stroke unit with those who weren't.
Indiana University announced in March that it is starting that state's first mobile stroke unit and will participate in a national study of six units.
The debate is settled for Darren Smith, who returned to Michigan for rehab. Health insurance provided by his job as a mail carrier has covered almost all of his medical bills, except for the $1,200 cost of an ambulance ride from Cleveland to Michigan.
Despite having to use a wheelchair and negotiate around his paralyzed left arm, Smith feels lucky to be alive and able to sip one of the Gene Simmons signature sodas that the rock icon sent to him.
"The mobile stroke unit saved my life," Smith said. "I could have died."