Stroke is one of the leading causes of death and long-term disability in India, placing a massive burden on families and the healthcare system. In a stroke, every minute matters; nearly 1.9 billion brain cells are lost every minute when treatment is delayed. Timely care within the “golden hour” can significantly reduce mortality and prevent lifelong disability. Yet, across much of India, especially in rural and remote regions, reaching a stroke-ready hospital within this critical window remains a major challenge.
Delays in transportation, lack of awareness about stroke symptoms, shortage of specialised facilities, and difficult terrain often mean that patients arrive too late to receive life-saving clot-busting treatment. Addressing this urgent gap between symptom onset and treatment, the Indian Council of Medical Research (ICMR) has taken a major step by handing over two Mobile Stroke Units (MSUs) to the Government of Assam.
The initiative marks a fundamental shift in stroke care delivery, from patients struggling to reach hospitals to hospitals reaching patients at their doorstep. Developed under the leadership of Prime Minister Narendra Modi and the guidance of Union Health Minister JP Nadda, the programme reflects the government’s commitment to extending advanced healthcare services to the poorest, most marginalised and vulnerable populations, including women, even in India’s most challenging geographies.
By integrating cutting-edge technology with emergency medical services, India has now become the second country globally to successfully deploy Mobile Stroke Units within rural emergency response systems, a milestone that could reshape stroke care in low-resource settings.
How prevalent are strokes in India?
India’s stroke burden is both massive and rapidly increasing. According to data from the National Stroke Registry Programme (NSRP), the country reports between 119 and 145 stroke cases per lakh population annually, with approximately 86.5 deaths per lakh population every year due to stroke. This translates into an estimated 14.4 to 16.6 lakh new stroke cases annually.
The situation has worsened over the past three decades. An analysis published in ‘The Lancet Neurology’ revealed that India has witnessed a 51 per cent increase in stroke cases between 1990 and 2021.
Time remains the single most critical determinant of stroke survival and recovery. Delays in reaching appropriate care continue to compromise treatment outcomes.
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This challenge was highlighted by a 2025 hospital-based study conducted at a tertiary care centre in southern India, which examined delays in transporting patients for thrombolytic therapy. The researchers noted, “The time taken to transport patients for thrombolytic therapy in stroke cases remains alarmingly high, compromising potential positive outcomes. Addressing these delays can enhance prehospital care and improve patient prognoses.”
The study aimed “to identify factors causing delays in treating acute stroke patients at a tertiary care hospital in southern India, to inform better practices and expedite care.” To assess this, caregivers of ischemic stroke patients were interviewed regarding treatment delays. Patients were categorised into two groups - those who arrived within the four-and-a-half-hour therapeutic window (Group A) and those who arrived later (Group B). Data on distance from hospital, transport availability, and mode of travel were analysed.
The findings revealed significant systemic gaps. Among 594 patients included in the analysis, 73.4 per cent arrived outside the recommended treatment window. Women constituted one-third of the total study population but accounted for only 20 per cent of patients who reached hospitals within the critical window. Younger patients were more likely to arrive early.
“The main reason for delays was a lack of awareness of stroke symptoms (53.2%), followed by initial care sought at non-stroke-ready hospitals (23%). Use of ambulances and vehicle ownership significantly correlated with faster arrivals, while distance to the hospital did not significantly affect timeliness,” the researchers further reported.
“Delays in stroke treatment are a major concern, linked to factors like age, gender, and transportation issues. No single factor independently predicted early hospital arrival. To improve outcomes, we need strategies that enhance public education, symptom recognition, and transportation—especially for vulnerable groups like women and the elderly,” the study concluded.
Similar barriers have also been documented in India’s northeastern region, where healthcare access remains limited. A prospective observational study conducted at the Department of Neurology, Gauhati Medical College and Hospital (GMCH), Assam, between January 2023 and March 2024, examined real-world challenges affecting thrombolysis delivery in acute ischemic stroke patients.
The researchers observed, “Timely thrombolysis significantly improves functional outcomes in acute ischemic stroke. However, implementation remains suboptimal in low‐resource settings.”
The study included 444 ischemic stroke patients who presented within 24 hours of symptom onset. Despite this, only 29 patients, just 6.5 per cent, received thrombolytic therapy.
Identifying the major obstacles, the study reported, “The most common barriers were delayed arrival beyond the 4.5‐hour window (63%), lack of symptom awareness (52%), ambulance unavailability (38%), imaging and consent delays (22%), and elevated blood pressure (17%). Financial constraints were a factor in 11%. Most patients originated from rural areas.”
“Real‐world barriers continue to hinder thrombolysis implementation in India. Public education, prehospital care reforms, and streamlined stroke protocols are crucial to improving outcomes in underserved regions,” it concluded.
What is a Mobile Stroke Unit (MSU)?
A Mobile Stroke Unit is a “mobile hospital on wheels, equipped with a CT scanner, teleconsultation with specialists, point-of-care laboratory, and clot-busting drugs, enabling early diagnosis and treatment of stroke at or near the patient’s home. This innovation is especially crucial for remote and difficult terrains, where travel to hospitals can take several hours. Through specialist teleconsultation, the MSU enables early identification of stroke type and rapid initiation of treatment—saving lives and preventing disability.”
Why the Northeast is in focus
The Northeast has a “disproportionately high burden of stroke. Difficult terrain, long distances, and limited access to specialised care have historically made timely stroke treatment challenging.”
To address this gap, ICMR established a neurologist-led stroke unit at Assam Medical College & Hospital, Dibrugarh, and physician-led stroke units at Tezpur Medical College Hospital and Baptist Christian Hospital, Tezpur. The Mobile Stroke Units were embedded into this pre-hospital stroke care pathway.
The results have been transformative. The model reduced treatment time from nearly 24 hours to about two hours, reduced deaths by one-third, and reduced disability by eight times. Between 2021 and August 2024, the MSU received over 2,300 emergency calls. Trained nurses screened 294 suspected stroke cases, with 90 per cent of patients treated directly from their homes. Integration of the MSU with the 108-emergency ambulance service expanded its reach to a 100 km radius.
Handing over the MSU to the Government of Assam, Dr Rajiv Bahl, Secretary, Department of Health Research and Director General, ICMR, said, “Mobile Stroke Units were first developed in Germany and later evaluated in major global cities. India has evaluated such units in a rural, remote, and difficult terrain in Northeast India. We are also the second country globally to report successful integration of an MSU with emergency medical services for treating rural acute ischemic stroke patients.”
Sharing the state’s experience, Shri P. Ashok Babu, Secretary & Commissioner, Health and Family Welfare, Government of Assam, said that “the handover strengthens Assam’s emergency response system and ensures continuity of this life-saving service under state ownership”. He noted that the collaboration with ICMR has enabled faster treatment, better coordination, and improved outcomes for stroke patients, and provides a strong foundation for expansion.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.
