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CONCLUSION
Patients with stroke in rural and remote areas around the world have an unacceptable inequity in access to
acute treatment compared to their urban counterparts. New approaches are urgently needed to overcome
this service delivery gap. The concept of an Air-MSU “bringing the stroke treatment to the patient” and
linked to telemedicine services may be a novel solution to allow diagnosis of stroke patients at the
emergency site. This is likely to facilitate faster triage and initiation of acute stroke treatment. The mobility
and flexibility of the Air-MSU concept may present a superior strategy to the more obvious and traditional
approach of overcoming tyranny of distance by establishing more on-site stroke capable health care
facilities. The development of novel diagnostic imaging and diagnostic tools may help reduce the cost of
implementation of an Air-MSU service. While early implementation is more likely in developed countries,
and further research is needed to understand the optimal technical and clinical settings, lessons learned may
later become important for developing nations. Also, careful cost benefit analysis for the individual settings
will be needed, which not only addresses the overall benefits but also the question of availability of
resources, costs of implementation, and financial sustainability, which are crucial factors for most countries
worldwide.

DECLARATIONS
Authors’ contributions
Wrote drafts of the manuscript, conceptualized ideas, provided inputs for all aspects of the manuscript
preparation and of the scientific content and reviewed the manuscript: Walter S, Easton D, Schwarz M,
Zhao H, Davis SM, Donnan GA
Conceptualized ideas, edited and critically reviewed and discussed the manuscript: Fassbender K, Gardiner
FW, Langenberg F, Dos Santos A, Bil C, Fox K, Bishop L, Coote S, Middleton S, Bladin C

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.

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