UVA team works with local rescue squads to diagnose stroke patients before they reach hospital

A University of Virginia Health System team is working with local rescue squads to diagnose stroke patients before they reach the hospital, enabling more patients to receive lifesaving treatment and have a full recovery.

Working through UVA Innovation's USEED fundraising program, UVA clinicians are raising $10,000 to equip two additional local ambulances with the iTREAT mobile telemedicine kit. The goal: Connect paramedics through a secure video link with UVA's specially trained stroke neurologists and emergency medicine physicians, who can diagnose stroke patients while they're in the ambulance and enable treatment to begin as soon as patients arrive at the hospital.

"The longest delay in treating folks is not once they get to the hospital but before they get to the hospital," said stroke neurologist Andrew Southerland, MD.

Why Is a Speedy Diagnosis Important?
Fast diagnosis and treatment is vital because the most effective treatment for acute ischemic stroke patients - the clot-busting drug tPA - is only safe and effective if delivered within three hours of when symptoms begin. Due to delays in reaching a hospital and receiving a diagnosis, less than 5 percent of all stroke patients receive tPA.

Getting stroke patients treated quickly is even more challenging for patients living in remote, rural areas of central and southwest Virginia, where it may take an ambulance 30 minutes or longer to get patients to an emergency room or stroke center.
"iTREAT is really designed to help support patients from rural communities to get the care they need quickly," said David Cattell-Gordon, director of the UVA Office of Telemedicine. "Every minute in a stroke matters."

Connecting Stroke Neurologists, ER Doctors with Patients
The iTREAT seeks to make productive use of those long ambulance transports to diagnose stroke patients. The UVA partners - the UVA Stroke Center, UVA Department of Emergency Medicine and the UVA Center for Telehealth - are working with the Thomas Jefferson Council for Emergency Medical Services to equip regional rescue squads with the iTREAT mobile telemedicine toolkit. Equipment includes a tablet device, secure videoconferencing technology, a high-speed modem, and a magnetic antenna to mount on the outside of the ambulance.

UVA and the Thomas Jefferson Council are working to equip a total of 12 ambulances in Albemarle, Greene, Louisa and Nelson counties with the iTREAT toolkit, said Sherita Chapman, MD, a vascular medicine fellow at UVA. "What we're trying to improve is treatment times for stroke patients [in these counties]," she said.
Southerland estimates it will cost about $5,000 to equip each additional ambulance with the iTREAT equipment.

Faster Care for a Variety of Patients
The iTREAT technology is in the testing stage with local rescue squads, Southerland said, with the hope of using it to care for Central Virginia patients in early 2014.
"If iTREAT is successful, we hope it can become a model for using telehealth to speed treatment for a range of emergency medical conditions," Southerland said.