Prehospital stroke study at the Universitair Ziekenhuis Brussel: preliminary data on 24/7 in-ambulance telemedicine for emergency stroke care

In-ambulance telemedicine for stroke (telestroke) is a promising concept.
Real-time bidirectional audiovisual communication between a patient in
a moving ambulance and a remote stroke expert can facilitate specialized
care at a very early stage. We have developed several prototypes for
in-ambulance telemedicine and we have created a telemedicine platform
encompassing standardized assessment of stroke severity using the Unassisted
TeleStroke Scale (UTSS), clinical decision support software for
stroke physicians and reporting functionality for the in-hospital team
awaiting the patient. Feasibility studies using this system in healthy volunteers
and in patients during paramedic emergency missions have
shown that this approach is safe, feasible and well-accepted by all
stakeholders.
We have completed a pilot study on 24/7 in-ambulance telestroke support,
confirming the safety, feasibility and reliability of this concept.We present
a video fragment of an in-ambulance teleconsultation from this trial.
Already during patient evacuation to the ambulance, vital data was
exchanged between the general practitioner present at the location and the
remote stroke physician. During emergency transportation to the hospital,
the teleconsultant examined the patient, alarmed the in-hospital team
and communicated critical information to the in-hospital team (patient
identification and date of birth, vital parameters, glycaemia, time of
symptom onset, stroke severity based on the UTSS, Glasgow Coma Scale
score, medical history, concomitant medication, suspected diagnosis,
checklist for treatment with intravenous thrombolysis, family contact
information, premorbid modified Rankin Scale score).
A single-center randomized clinical trial evaluating the efficacy, safety,
feasibility, reliability, and cost-effectiveness of in-ambulance telestroke is
currently ongoing.