Telestroke Ambulances in Prehospital Stroke Management

Abstract

Background and Purpose-Pre-and intrahospital time delays are major concerns in acute stroke care. Telemedicineequipped ambulances may improve time management and identify patients with stroke eligible for thrombolysis by an early prehospital stroke diagnosis. The aims of this study were (1) to develop a telestroke ambulance prototype; (2) to test the reliability of stroke severity assessment; and (3) to evaluate its feasibility in the prehospital emergency setting. Methods-Mobil, real-time audio-video streaming telemedicine devices were implemented into advanced life support ambulances. Feasibility of telestroke ambulances and reliability of the National Institutes of Health Stroke Scale assessment were tested using current wireless cellular communication technology (third generation) in a prehospital stroke scenario. Two stroke actors were trained in simulation of differing right and left middle cerebral artery stroke syndromes. National Institutes of Health Stroke Scale assessment was performed by a hospital-based stroke physician by telemedicine, by an emergency physician guided by telemedicine, and "a posteriori" on the basis of video documentation. Results-In

Prehospital Triage and Emergency Room Care in TBI

“…Subsequently, this system has been adopted in the official Neurosurgical Society of Australasia (NSA) and Royal Australasian College of Surgeons (RACS) neurotrauma guidelines [77]. This system has proved its validity in stroke patients [78,79] and in treating myocardial infarctions [80].…”

A low-cost, tablet-based option for prehospital neurologic assessment

“…Although promising, these pilot studies demonstrated technical challenges including earlier-generation broadband, limiting technical feasibility. [8][9][10] More recent studies incorporating modern cellular connectivity have shown greater reliability but involve costly telemedicine endpoints and a limited geographic scope primarily confined to urban areas. 11,12 The objective of our study, Improving Treatment with Rapid Evaluation of Acute Stroke via Mobile Telemedicine (iTREAT), is to demonstrate the reliability and technical feasibility of bidirectional, ambulance-based videoconferencing using a low cost, portable mobile telestroke system.…”

“…During technical feasibility testing at the UVA site, we developed a connectivity map by recording AV quality during live videoconferencing along each of our 6 primary ambulance routes. AV quality was recorded using an adapted 6-point scale 9 as measured by 2 independent raters from both the vehicle and hospital. We also recorded the time of continuous, uninterrupted video transmission along each route.…”

“…8 More recent mobile telestroke demonstrations in Europe have shown conflicting but promising feasibility results, highlighting the importance of 4G vs 3G mobile broadband to achieve reliable continuous connectivity for uninterrupted communication. [9][10][11] In the United States, investigators in Houston, TX, reported successful feasibility and reliability of telemedicine in a mobile stroke unit using the RPXpress portable telemedicine system from InTouch Technologies, Inc. (Santa Barbara, CA). 12 Similar to our study, they utilized patient actors performing simulated stroke scenarios during ambulance transport and were able to demonstrate excellent intraclass correlation (0.997, 0.97-0.998) for the NIHSS score between real-time and scripted scenarios.…”

Prehospital stroke care

“…Telemedicine with video examination of stroke patients in ambulances for earlier stroke recognition has been reported in 2 recent studies. 32,33 While TeleStroke assessment appears feasible in general and has become routine care in many hospitals, 34 data transmission based on the third-generation mobile communication technology currently available was not stable enough for routine use in the prehospital setting. 33 The increasingly available fourth-generation technology is being tested in several regions and may offer major advantages by higher bandwidth (particularly in the upload stream) and by prioritizatized connection.…”