Arkansas Stroke Telemedicine: Bits, Bytes & Better Care Ken Kelley BBA, NRP, IC, CAPO, CACO, CAC, CADS ARKANSAS STROKE CONFERENCE Hot Springs, Arkansas Sept 26, 2019
Objectives Define telemedicine Early concepts of mobile stroke units Arkansas Pilot Prehospital Stroke Telemedicine Program Telemedicine Advanced Stroke Exam Technology Pitfalls & Promising Technologies
Telemedicine The use of technologies, equipment and applications that allow health care professionals the means to evaluate, diagnose and treat patients in remote locations. Telemedicine allows patients in remote locations to access medical expertise quickly, efficiently and without travel. Telemedicine provides more efficient use of limited expert resources who can "see" patients in multiple locations.
Feasibility of Prehospital Teleconsultation in Acute Stroke – A Pilot Study in Clinical Routine May 2012 Bergrath, Sebastian & Reich, Arno & Rossaint, Rolf & Rörtgen, Daniel & Gerber, Joachim & Fischermann, Harold & Beckers, Stefan & Brokmann, Jörg & Schulz, Jörg & Leber, Claas & Fitzner, Christina & Skorning, Max. (2012). Feasibility of Prehospital Teleconsultation in Acute Stroke – A Pilot Study in Clinical Routine. PloS one. 7. e36796. 10.1371/journal.pone.0036796. “The possibility of a remote connection to a stroke expert rather than one physically present in the MSU could have the advantage of broader availability of expertise to the MSU.”
Meta-analysis: Evaluating Stroke Workflow 11 studies Highly significant weighted mean difference of 37 minutes time saved through workflow interventions Time saved translates to disability-free life for our patients. Comprehensive Stroke Center (CSC) vs. Primary Stroke Center (PSC) Early prenotification Utilizations of mobile stroke units (MSU) “Ship & Drip” vs. “Drip & Ship” protocols for thrombolytics Vessel imaging at PSC, cloud-based image sharing & tele-stroke technologies Ground vs. Air transfer protocols
Leading Through Innovation and Technology October 1, 2018 Leading Through Innovation and Technology
Bringing a world of health care close to home AR SAVES Stroke Ready Hospitals Medical Center of South Arkansas Magnolia Regional Medical Center Ouachita County Medical Center Ashley County Medical Center
REAL TIME COMMUNICATIONS ONLINE MEDICAL CONTROL
Advanced Prehospital Stroke Exam
Team Feedback
TeDir (TeleDiagnostics in prehospital emergency medicine) trial by Geisler et al “We can conclude that, although additional outcomes and cost‐effectiveness research is certainly needed, telestroke over cellular represents an exciting application of wireless communications and its roll out may ultimately prove to be useful in improving stroke outcomes across the globe.”
Pitfalls & Promising Technologies The #1 pitfall thus far from the pilot study relates to communications connectivity. “In 2018, the Federal Communications Commission found that ≈15 million Americans were outside of service areas that offered 10‐megabit per second download speeds.” “Poor cellular connection was among the factors that caused a remote failure rate of approximately 10%” “Rapid failover to lower bandwidth communication methods while en route to the hospital may ultimately still be necessary. Reliability of the network is likely to be a constant concern as the MSU and networks are expanded.”
Time is Brain …. Speed is King!
applied technology will transform all these areas. Conclusion The major challenges to tackle for future improvement in prehospital stroke care are that of public awareness, emergency medical service detection, and triage, and improved systems of stroke care. Thoughtfully applied technology will transform all these areas. June 14, 2019