Clotting in the brain’s blood vessels is the major cause of stroke. In the case of clotting in smaller blood vessels, clot-dissolving drugs, thrombolytics, are normally given to patients. However, clotting in larger blood vessels is handled by removing the clot through a surgical procedure—thrombectomy. Regardless of the treatment needed, receiving the right care during the stroke is crucial.
Emergency Medical Services (EMS) clinicians are the first point of access to care for most patients with stroke symptoms. However, previous studies have indicated that EMS clinicians fail to identify 35% of stroke patients. To minimize the time needed for treatment, ambulances usually call nearby hospitals to determine whether patients need a thrombolytic or thrombectomy.
As part of the initiative to improve and transform prehospital stroke care, Sweden will video stream and consult Emergency Medical Services clinicians in ambulances by connecting them with hospital-based neurologists.
“Using video streaming and consultation in the ambulance, stroke patients can quickly and remotely be assessed by a neurologist and driven directly to the hospital that can provide them with the best care. The biggest difference can be felt by the people who live furthest away from a specialist hospital. So, in addition to better care outcomes, this means more equal care for each stroke patient,” says Stefan Candefjord, the author of the project VIPHS (Video Support in the PreHospital Stroke Chain).
Previous work has shown a positive impact of real-time video streaming. Video consultation appears to be a reliable and feasible tool to increase the rate of thrombolysis in rural regions. Setting up telemedicine networks between central and community hospitals can greatly benefit underserved areas.
“With video cameras in the ambulances, we can make today’s stroke care even better for more patients. The same neurological assessment that the doctor does in a hospital can now be done at a much earlier stage in the ambulance. This process is a team effort that involves many people from different parts of the care chain, where everyone is important to reduce the number of minutes it takes to treat the stroke patient,” says Mikael Jerndal.
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The given studies are part of a longer project VIPHS (Video Support in the PreHospital Stroke Chain), which started in 2015/2016. VIPHS includes step-wise development of methods like process analysis and technical proposal, realistic full-scale simulations, operation testing, and clinical implementation.
Researchers collaborated with four ambulance teams to evaluate the video-assistance decision support system. These ambulances were equipped with three cameras connected to stroke specialists at Sahlgrenska University Hospital in Gothenburg. The first camera was focused on capturing the facial expressions of the patient, the second camera was pointed at the side of the patient to assess the ability to lift and hold up their arms, and the third camera captured legs.
Neurologists directed the clinicians in the treatment using the cameras and working prototype installed as a permanent set-up in the patient compartment in an ambulance.
The simulation study proved to be successful. All the EMS clinicians expressed satisfaction with their participation in the study and appreciated the pivotal role played by the neurologists in carrying out the operation.
“In future work video consultation will be pilot-tested in a limited clinical setting. Practical issues like bandwidth limitations need to be handled. Clinical benefit will be evaluated by examining times for thrombolysis and thrombectomy treatment, respectively.”
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“Other valuable evaluations from a pilot test are to improve the work process in connection with video consultation via interviews with EMS clinicians and neurologists,” says the study.
Journal Reference:
- Candefjord, S., Andersson Hagiwara, M., Sjöqvist, B.A. et al. Video support for prehospital stroke consultation: implications for system design and clinical implementation from prehospital simulations. BMC Medical Informatics and Decision Making 24, 146 (2024). DOI: 10.1186/s12911-024-02539-7