New Video Streaming in Ambulances Can Improve Stroke Care

A study led by Chalmers University of Technology, in Sweden, showed how if ambulance staff can consult a stroke specialist via video streaming inside the ambulance, before departure, can save lives and prevent permanent brain damage. The study gathered all key professional groups required when someone suffers an acute stroke. 
 
The researchers behind the study pointed out that it is important to identify as early as possible, and with high precision, which patients need which care. With the video streaming support, it is possible to enhance an existing care process for selected patients, which is currently based on telephone calls between ambulance personnel and specialist doctors.  
 
A stroke is mostly caused by a clot in the blood vessels of the brain. In the case of clots in the larger vessels of the brain, significantly better results are achieved if the blood clot can be removed through a surgical procedure – thrombectomy. Since it is quite a complicated procedure, it can only be performed at specialist hospitals like university hospitals, such as Sahlgrenska University Hospital in Gothenburg, Sweden. 
 
Regardless of the treatment needed, a CT (computed tomography) image examination of the brain is initially done at the hospital to assess the situation and the type of stroke. If the patient has been transported to a nearby emergency hospital, further transport is then usually required to be able to offer thrombectomy.
 
“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,” said Stefan Candefjord, who is a researcher in digital health at the Department of Electrical Engineering at Chalmers and first author of a new scientific study within the project VIPHS (Video Support in the PreHospital Stroke Chain). 
 
“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,” stated Mikael Jerndal, neurologist and chief physician at the stroke unit at Sahlgrenska University Hospital in Gothenburg.
 
To test and evaluate how a video-assisted decision support system can work in practice, realistic full-scale simulations were conducted. Four ambulance teams received alerts about people with stroke symptoms of varying severity. The patients were played by neurologists and the ambulances were equipped with three cameras that were connected to stroke specialists at Sahlgrenska University Hospital in Gothenburg. 
 
In the study, the first camera focused on the patient’s face, so that an assessment of facial expressions, as well as head and eye movements, could be made. The second camera was angled towards the side of the patient, to give a general overview and assess the ability to lift and hold up their arms. A third camera showed the patient’s legs, to make a similar assessment as for the arms.
 
“A decision in the ambulance to transport a patient directly to Sahlgrenska University Hospital is estimated to save one and a half hours in processing time for patients who live outside Greater Gothenburg. This can be a life-changing timesaving for those who need a thrombectomy, as an hour’s delay is estimated to halve the effect of the treatment. Every year, a significant number of people could have a completely different life if they had a thrombectomy faster,” commented Bengt Arne Sjöqvist, Professor Emeritus of digital health at the Department of Electrical Engineering at Chalmers, and co-author of the scientific article.
 
After the simulation study, a clinical pilot study was carried out with three ambulances and actual stroke patients, in a region outside of Gothenburg – Södra Älvsborg. 
 
The pilot study was successful, and the results and experiences were transferred to Region Västra Götaland , the responsible healthcare stakeholder, as part of its investment and promotion of increased healthcare digitalization.
 
“With the primarily responsible stakeholder as project lead, the intention was to manage a critical phase in utilisation as well as regional adaptation, deployment and future form of operation, a work that is still ongoing.  Of course, we hope that the positive results from our work will soon be shared by patients, and then also in other places. Disseminating and sharing our results and experiences, as well as helping everyone who wants to test and implement, is important to us,” said Bengt Arne Sjöqvist.