The rapid administration of IV rt-PA to eligible patients with ischemic stroke is associated with better outcomes. The American Heart Association recommends a Door-to-needle (DTN) time <60 minutes.  Telemedicine is a safe and effective alternative to the bedside evaluation for rapid diagnosis and treatment of acute ischemic stroke for IV rt-PA administration. Our previous pilot study established feasibility of in-ambulance, prehospital telemedicine for measuring the NIH Stroke Scale (NIHSS) on suspected stroke patients. This intervention saved an average of 7.5 minutes.  We hypothesized that we could effectively train neurology residents to use telemedicine to accurately measure pre-hospital NIHSS while patients were still in the ambulance. 

Two standard ambulances were equipped with InTouch Xpress telepresence devices.  Using a simulation center, we trained all neurology residents using a simulated live stroke patient scenario to obtain the NIHSS in a moving ambulance.   A multidisciplinary team facilitated implementation of the three phase training modules: Phase I didactic briefing, Phase II live viewing of the EMS ambulance system, and Phase III- ‘go live’ simulated NIHSS stroke patient run.

92% (11/12) neurology residents were able to complete Phase I-III training within the simulated environments.  To date, at least three stroke patients from were evaluated successfully during transport.  Ongoing, bidirectional standardized feedback is being obtained from neurology resident and EMS providers for continuous quality improvement for stroke transfers.

92% (11/12) neurology residents were able to complete Phase I-III training within the simulated environments.  To date, at least three stroke patients from were evaluated successfully during transport.  Ongoing, bidirectional standardized feedback is being obtained from neurology resident and EMS providers for continuous quality improvement for stroke transfers.