Video streaming from ambulances could improve stroke outcomes
A new study suggests that video consultations between ambulance staff and stroke specialists could lead to faster, more precise treatment decisions for acute stroke patients, potentially saving lives and reducing long-term disability.
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.
© Magnus Andersson Hagiwara and Hanna Maurin Söderholm
Researchers from Chalmers University of Technology in Sweden have demonstrated that equipping ambulances with video streaming technology could significantly enhance the prehospital stroke care process. The study, published in BMC Medical Informatics and Decision Making [1], involved full-scale simulations to evaluate the feasibility and potential benefits of this approach.
Enhancing prehospital stroke assessment
The current standard of care for suspected stroke patients typically involves ambulance staff consulting with hospital-based specialists via telephone. However, this method has limitations in terms of the information that can be conveyed accurately.
To address this, the research team equipped ambulances with three strategically placed cameras: one focused on the patient’s face to assess facial expressions and eye movements, another providing a general overview of the patient’s upper body to evaluate arm function, and a third camera aimed at the legs for lower limb assessment.
These cameras were connected to stroke specialists at Sahlgrenska University Hospital in Gothenburg, allowing for real-time video consultations. This setup enabled neurologists to perform detailed assessments remotely, similar to those conducted in hospital settings, but at a much earlier stage in the care process.
Potential time savings and improved treatment decisions
One of the most significant findings from the study was the potential time saved in critical decision-making. Stefan Candefjord, a researcher in digital health at Chalmers University of Technology and the study’s first author, explained: “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.”
This approach could be particularly beneficial for patients living further away from specialist stroke centres. The researchers estimate that for patients outside Greater Gothenburg, a decision to transport directly to a specialist centre like Sahlgrenska University Hospital could save up to one and a half hours in processing time.
Implications for thrombectomy candidates
The time saved could be especially crucial for patients who may require mechanical thrombectomy, a procedure to remove large vessel occlusions that can only be performed at specialist centres. Bengt Arne Sjöqvist, Professor Emeritus of digital health at Chalmers and co-author of the study, noted: “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.”
By enabling earlier and more accurate triage, the video consultation system could help ensure that patients are taken directly to the most appropriate facility for their specific condition, potentially improving outcomes and reducing the need for inter-hospital transfers.
From simulation to clinical implementation
The study involved realistic full-scale simulations with four ambulance teams responding to alerts about people with varying stroke symptoms. Following the success of these simulations, a clinical pilot study was conducted with three ambulances and actual stroke patients in the Södra Älvsborg region outside Gothenburg.
Mikael Jerndal, a neurologist and chief physician at the stroke unit at Sahlgrenska University Hospital, emphasised the collaborative nature of the project: “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.”
Future directions and potential impact
The positive results from the pilot study have been transferred to Region Västra Götaland, the responsible healthcare stakeholder, as part of its investment in increased healthcare digitalisation. The researchers hope that their findings will soon benefit patients in other regions as well.
Professor Sjöqvist highlighted the importance of disseminating their results and experiences: “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.”
While the video consultation system shows promise, the researchers are also exploring other tools to increase the precision of early decisions in stroke care, including potential applications of artificial intelligence methods.
Reference:
- Candefjord, S., Andersson Hagiwara, M., Sjöqvist, B.A. et al. Video support for prehospital stroke consultation: implications for system design and clinical implementation from prehospital simulations. BMC Med Inform Decis Mak 24, 146 (2024). https://doi.org/10.1186/s12911-024-02539-7
