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Cover Story: Telestroke:

Taking Telemedicine Mobile

to Curb Stroke Damage

Continued from page 1 that, in addition to the 1.9 million neu-
The criteria for calling a “stroke alert” rons, patients experiencing a typical
was only slightly more advanced than large vessel acute ischemic stroke lose 14
the FAST exam. EMS and hospitals billion synapses, and 12 km (7.5 miles)
focused on the patient but weren’t work- of myelinated fibers each minute. With a
ing together. That alone often delayed trained EMS crew using telemedicine,
definitive treatment at a hospital with that critical first phase of treatment –
stroke specialists. As medically trained including stroke recognition, neurologi-
paramedics, the EMS community real- cal assessment and CT imaging – begins
ized there was room for improvement in almost immediately and is followed by
this link. intervention and recovery.
Shifting the NIHSS assessment from a
Stroke Scales fixed environment to a moving ambu-
To improve assessments, paramedics lance presented initial challenges.
began using advanced field stroke triage Overcoming those challenges required
scales such as the Rapid Arterial collaboration. Key stakeholders adopted
Occlusion Evaluation (RACE), Los various training methods, extensive test-
Angeles Motor Scale (LAMS), and Field ing and troubleshooting to achieve stan-
Assessment Stroke Triage for Emergency dardized, reproducible NIHSS assess-
Destination (FAST-ED). These stroke ments with the same quality and accura-
scales allowed EMS responders to trans- cy of bedside tests.
port stroke patients directly to appropri- Advanced training was provided with
ate comprehensive stroke centers, where the technology via multiple trials, simu-
treatment windows can be up to 24 lations and active training with identi-
hours from last known well (LKW). fied “superusers” at all points of connec-
Neurologists and hospitals began to see tion. Paramedics also trained directly
the benefit of using pre-hospital with neurologists and other specialists
providers to promote better patient out- for advanced education on NIHSS assess-
comes. Because with a stroke, the clock ments, alteplase (tPA) infusions, blood
is ticking. products and ventilator management.
A patient with an ischemic stroke can Training and testing were meticulous
lose 1.9 million neurons every minute prior to going live in the field, and con-
without intervention. The advanced field tinue through real-time feedback in our
stroke assessments proved highly valu- search to improve our technology and
able in determining the appropriate hos- interventions.
pital destinations. Still, more needed to Since August 2018, Century
be done in the field to reduce door-to- Ambulance has been at the forefront of
needle times. curbing total brain tissue lost during
The National Institutes of Health hospital-to-hospital transfers by using
Stroke Scale, or NIHSS, is the gold stan- telemedicine in critical-care mobile
dard stroke tool that quantifies neurolog- units. The program is appropriately
ic impairment, severity and location. named Telestroke. Because of Telestroke,
NIHSS also strongly correlates to associ- neurology teams in comprehensive
ated outcomes and benefits from reper- stroke centers can conduct patient neu-
fusion therapies. For example, a positive rological assessments with the assistance
score in the limb ataxia assessment can of the transporting EMS crews while the
indicate a cerebellar lesion; a positive patient is in route.
score in the sensory screening may indi- The time saved may appear insignifi-
cate brainstem involvement. This highly cant, but it can improve patient out-
valuable tool was only performed in hos- comes on a grand scale by saving pre-
pitals and only by specialty trained cious brain tissue and neurological func-
providers, until now. tion. In addition to the training men-
tioned above, the EMS crews directly
Leveraging Telemedicine to involved with Telestroke have received
Perform NIHSS Assessment in years of clinical experience and higher
the Field education via critical-care certifications.
Century Ambulance has partnered Telestroke combines state-of-the-art
with medical leaders in comprehensive mobile telemedicine, real-time neurolog-
stroke management to leverage telemed- ical intensivist assessment, and EMS pro-
icine technology to connect with the fessionals with advanced training to
receiving neurologists to perform this diagnose and appropriately manage crit-
NIHSS assessment in the field. The pro- ical stroke patients. This innovative pro-
gram shaves an average of 7.5 minutes gram is a natural for the EMS communi-
off treatment times through HIPAA-com- ty. Our passion is saving lives. And
pliant remote videoconferencing. That’s Telestroke unifies that passion with
an average savings of 14.25 million neu- advanced training, neurology specialists
rons per patient. and adaptation of emerging technology
Telemedicine has become an accepted in a new way that not only saves lives but
form of healthcare. Now, this integral also helps make the lives we save the
tool has reduced the ticks of the clock best they can be.
until treatment by providing early com-
prehensive stroke assessment and appro- Heather Stores is training manager,
priate care. And every clock-tick counts. and Jeff Avinger is station supervisor,
The American Heart Association says
with Century Ambulance.

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8 January 2020 southfloridahospitalnews.com South Florida Hospital News