Jennifer Dearborn, MD

Wu TC, Nguyen C, Androm C, Yang J, Persse D, Vahidy F, et al. Prehospital Utility of Rapid Stroke Evaluation Using In-Ambulance Telemedicine: A Pilot Feasibility Study. Stroke. 2014

“Time is brain” and current research efforts, such as utilization of the mobile stroke unit, have sought to decrease the door-to-needle time to deliver thrombolysis therapy (r-tPA) quickly and efficiently. Tzu-Ching Wu et al. explore how telemedicine can facilitate shorter door-to-needle times by performing the stroke assessment while en route to a nearby stroke facility. In this pilot study, EMS providers are trained to interact with a telemedicine program that communicates with a remote vascular neurologist to perform the NIH stroke scale. This pilot study was a feasibility and reliability assessment of the technology, which used trained actors in different settings to complete remote and real-time assessments of the same scenarios. The authors found that the telemedicine approach was feasible in the majority (85%) of scenarios, and that common reasons for malfunction was due to cell phone connections through the network. There was also moderate to excellent reliability with the NIHSS compared to real-time raters.



This pilot study is important because it shows that an easy to introduce technology that is commonly used in other hospital emergency rooms is feasible in the ambulance and emergency setting. This approach has the potential to rapidly triage patients upon arrival in the emergency room to thrombolysis, with the final decision pending only a CT scan evaluating for hemorrhage. As the majority of thrombolysis cases are staffed by a vascular neurologist upon hospital arrival, this approach does not add many costly resources, and instead could save time and brain. I am excited to see if use of this technology is incorporated into EMS care. If it is proven to be effective in one system, other regions will incorporate it into the ambulance-based care of stroke patients.