Abstract 103: Mobile Telestroke During Ambulance Transport is Feasible in a Rural EMS setting - pilot data from the Improving Treatment with Rapid Evaluation of Acute stroke via mobile Telemedicine (iTREAT) study
Introduction: The American Heart Association-American Stroke Association (AHA-ASA) Target:Stroke iniative calls for innovative approaches to prehospital stroke care. We hypothesize that mobile telestroke from a hospital-based neurologist to an ambulance-based provider, using tablet devices and commercially available broadband, will facilitate earlier stroke diagnosis and more accurate prenotification to reduce stroke onset-to-treatment times.
Methods: We assessed the technical feasibility of mobile teleconferencing along the six common rural emergency medical service (EMS) routes into the University of Virginia Medical Center, allowing a minimum travel time of 15 minutes and continuous connectivity of 5 minutes. Our mobile telestroke platform included Apple iPad with retina display, high-speed 4G LTE modem, Cisco Jabber secure video conferencing application, and magnetic-mount external antennae. Continuous mobile connectivity was facilitated through the commercial Verizon Wireless network. Continuous transmission audiovisual (AV) quality along each route was rated by independent raters from both hospital and vehicle using a standardized six-point scale (≥4 indicating technical feasibility).
Results: Of 31 test runs, two had extraneous technical issues and one failed to meet the minimum duration for continuous connectivity. The mean transmission video quality rating was 4.51 (4.54 vehicle; 4.48 hospital) and overall audio quality 5.00 (5.13 vehicle; 4.87 hospital). Both raters deemed AV quality as "good" or "excellent" (rating ≥4) for 78.5% of test runs. Five out of six EMS routes consistently demonstrated feasible connectivity, with 87.5% of runs achieving "good" or "excellent" bidirectional AV quality for these five routes.
Conclusion: Our pilot data suggest technical feasibility for mobile teleconferencing between transporting ambulance and hospital-based provider using low-cost, off-the-shelf technology and commercial networks. These results support our hypothesis that mobile telestroke in a rural EMS setting can be implemented. Further troubleshooting along routes with limited connectivity, and prospective testing of the impact on stroke diagnosis and time-to-treatment is planned.
Author Disclosures: J.M. Lippman: None. S.N. Chapman: None. B. Gunnell: None. T.L. McMurry: None. P. Mehndiratta: None. D.M. Burns: None. D.G. Perina: None. N.J. Solenski: None. B.B. Worrall: Other Research Support; Modest; Genetic Risks for Medication-Related Hemorrhagic Stroke (GOCHA) NINDS/NIH- R01 NS 42147 Moderate, The NINDS International Stroke Genetics Consortium (Stroke Genetics Network (SiGN)) NINDS/NIH – U-01 NS069208 Moderate, Part of the Genomics and Randomized Trials Network (GARNET) - Pharmocogenomic studies in VISP: results and implications for clinical trial design NHGRI/NIH – U-01 HG005160 Moderate. Other Research Support; Significant; Ethnic/Racial variation in IntraCerebral Hemorrhage (ERICH) NINDS/NIH- R01 NS 069763 Significant. Other; Significant; Associate Editor for Neurology journal. A.M. Southerland: Research Grant; Modest; NINDS UO1 HG005160 Genomics and Randomized Trials Network (GARNET), NINDS UO1 NS069498 Stroke Hyperglycemia Insulin Network Effort (SHINE), NHLBI RO1 HL67025 Placement of Aortic Transcatheter Valves Trial (PARTNER II) Neuro substudy, UVA Neuroscience Center of Excellence - Capital Support Project. Research Grant; Significant; AHA 3CRP14140001 National Clinical Research Program, Cervical Artery Dissection Expression (CADEX). Honoraria; Modest; Allere Informatics Solutions. Consultant/Advisory Board; Modest; Totier Technologies - Clinical Research Advisor. Other; Modest; Associate Editor - Neurology Podcast.
- © 2014 by American Heart Association, Inc.