Prehospital Telemedical Support in Acute Stroke

Study Overview
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Brief Summary
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The aim of the study is to investigate the quality of prehospital emergency care in acute stroke, when paramedics are supported telemedically by an EMS physician.

Detailed Description
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Six ambulances from five different Emergency Medical Service (EMS) districts are equipped with a portable telemedicine system. In cases of suspected acute stroke (including intracranial hemorrhage), the paramedics can use this system to contact a so called tele-EMS physician after consent of the patient is obtained. The tele-EMS physician has an audio-connection to the EMS team and receives vital parameters (e.g., ECG, pulse oximetry, non-invasive blood pressure) in real-time. The transmission of still pictures (taken with a smartphone), 12-lead-ECGs and video streaming from the inside of the ambulance can also be carried out, if indicated. The tele-EMS physician supports the EMS team in obtaining all relevant medical history, neurological diagnosis, general diagnosis and can delegate the application of medications. This can be carried out to bridge the time to the arrival of an EMS physician or in less severe cases without an EMS physician on-scene. The quality of prehospital care and the possible influences on the initial inhospital phase should be investigated and compared with regular EMS.

Official Title
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Prehospital Telemedical Support in Acute Stroke

Conditions
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Acute Stroke

Intervention / Treatment
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* Procedure: Teleconsultation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: suspected acute stroke verbal consent for teleconsultation obtained or patient is not able to consent due to the severity of the emergency Exclusion Criteria: no suspected stroke patient refuses consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Device: Teleconsultation<br>In cases of suspected acute stroke (including intracranial hemorrhage), if patients give informed consent the paramedics can use this system to contact a so called tele-EMS physician who has an audio-connection to the EMS team and receives vital parameters (e.g., ECG, pulse oximetry, non-invasive blood pressure) in real-time. The transmission of still pictures (taken with a smartphone), 12-lead-ECGs and video streaming from the inside of the ambulance can also be carried out, if indicated. The tele-EMS physician supports the EMS team in obtaining all relevant medical history, neurological diagnosis, general diagnosis and can delegate the application of medications. This can be carried out to bridge the time to the arrival of an EMS physician or in less severe cases without an EMS physician on-scene. The quality of prehospital care and the possible influences on the initial inhospital phase should be investigated and compared with regular EMS. | Procedure: Teleconsultation<br>* Teleconsultation of an EMS physician in cases of suspected acute stroke<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of prehospital care | Analysis of the quality of prehospital care on the basis of published guidelines for acute stroke | average 1 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical time intervals | Prehospital and in-hospital time intervals: on-scene-time, contact to hospital time, door (hospital) to cerebral imaging, door (hospital) to thrombolysis | 12 hours | 
| Diagnostic quality | Comparison of prehospital and definitive diagnosis | up to 28 days | 
| Information transfer | Amount of stroke specific information that is transferred to the admitting hospital. | 2 hours | 
| choice of appropriate hospital | Evaluation how many patients are transported to an appropriate facility (stroke unit) | average 1 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stroke, teleconsultation, telemedicine, emergency medical service