Stroke-capable ambulances hit the road

Paramedics in regional Victoria and NSW are using new digital apps to enhance diagnosis of acute stroke in the field. Supported by hospital-based neurologists connected via telehealth, the paramedics aim to enhance diagnosis decisions and to assist in the triage of patients for faster treatment.

Over 60 vehicles in Ambulance Victoria and NSW Ambulance will be transformed with this new digital telestroke technology. The initial pilots will involve 322 paramedics in Victoria and 400 in NSW. The aim is to treat 80 patients as an early proof of concept for this new model of prehospital care.

Key points:

  • Paramedics are the critical first responder clinicians for stroke patients. The chain of survival relies on their fast response and accurate decision-making, so it’s hoped the new kit will enable a superior level of care to stroke patients
  • Paramedics are directly involved in diagnosis, with access to a telehealth neurologist, 24/7, using the Zeus stroke app developed by Titan Neuroscience, the telestroke partner of the Stroke Alliance
  • The app provides greater connectivity for the paramedics and, for the first time, a direct link to a neurologist if needed
  • More control, in the paramedic’s hand, helping to navigate the complex acute stroke care pathway
  • Communicating via the Titan app, the new ‘stroke-capable ambulance’ crew will transport patients to the most appropriate hospital for treatment (not simply the nearest)
  • The initiative will reduce secondary patient transfers, improve pre-hospital diagnosis and triage, with the aim to save precious time when every second counts. Time to treatment is expected to improve
  • The telehealth app has been co-designed with paramedics, for paramedics.

Why a stroke ambulance?

Globally, stroke is the second most common cause of death and a leading cause of disability. In Australia, there are 60,000 strokes annually, resulting in 12,000 deaths. The cost of disability, caused by stroke, is $5 billion per annum. The number of stroke survivors is expected to double by 2050, with a stroke occurring every four minutes.

The Australian Stroke Alliance is concentrating on regional implementation as part of its mission to improve access to urgent, prehospital care. Stroke incidence is 20 per cent higher in rural and remote areas with double the likelihood of significant lifelong disability than those who have a stroke in a metropolitan area. The tyranny of distance means rural and remote patients take longer to reach hospital and only 47 percent of those treated in a regional hospital, receive stroke unit care compared (to 77 percent of metropolitan patients).

Early treatment changes lives, according to Stroke Alliance principal investigator and Liverpool Hospital neurologist, Prof Mark Parsons.

Preventing the inevitable delays that occur in transferring patients between hospitals for brain-saving clot retrieval treatment is crucial. For every hour of treatment delay, there is a loss of one year of disability-free life.
Stroke Alliance principal investigator and Liverpool Hospital neurologist, Prof Mark Parsons

Patients suspected of having an ischemic stroke due to a large vessel occlusion will be directed straight to the relevant comprehensive stroke centre for intervention.

The Royal Melbourne Hospital and Southwestern Sydney hospitals will provide neurological expertise.

The app-based stroke tools will:

  • Enable rapid patient assessment with digitised scales such as the mHunter-8 or ACT-FAST for in-field identification of patients with a high index probability of having a large vessel occlusion (LVO)
  • Connect on-site paramedics to remote stroke experts to provide a real-time consultation where stroke is suspected
  • Enable direct triage to a thrombectomy centre for suspected LVO stroke patients
  • Pre-notify the clinical team at the comprehensive stroke centre and enable angio/neurointerventional team readiness for patient handover on arrival.

A single platform for those in the field

    The core features of the tool are:

    • An all-in-one platform that is easily accessible on currently used devices
    • Ability to connect with other users via audio/video linkage
    • Secure texting services with the ability to send photos and files
    • Customised patient assessment forms for region-specific care
    • Enhanced notification tools to inform all users across the health care continuum.
Zeus is more than an app; it’s a telestroke and communications platform designed to enable paramedic-led and nursing-led models of stroke care.
Stroke Alliance chief technology officer, Prof Andrew Bivard

Zeus is available as a web and mobile application for both Android and iOS devices.

The Zeus app will be used on both the stroke capable road ambulance project as well as new aeromedical stroke models of care involving air ambulance helicopters and fixed wing aircraft.

Paving the way for prehospital brain scans

    Brain imaging is critical to differentiate between ischaemic and haemorrhagic strokes. Currently, imaging must occur in major hospitals where heavy, immobile scanners are found.
    While modified CT scanners are now found in specialised mobile stroke ambulances around the world (including Melbourne and soon, Sydney), they are labour intensive and cannot be scaled up to serve regional communities.

    Motivated by the success of Melbourne’s mobile stroke unit, the Stroke Alliance is developing lightweight, portable imaging devices with the aim of making them a carry-on tool for paramedics.

    The launch of the stroke capable road ambulances in NSW and Victoria in October paves the way for the new devices to take an image of a patient’s brain at the scene of a stroke (planned for mid 2023).