Outcome from intravenous thrombolysis (IT) is heavily influenced by door-to-needle time (DTNT). The majority of patients with acute ischemic stroke arrive at hospitals via ambulance and are then assessed by neurologists. In this pilot study we examine if a field stroke assessment examination conducted in a moving ambulance can be transmitted reliably to neurologists at a stroke center.

Wifi enabled iPads were placed in 18 ambulances serving five rural counties in Southeast Georgia. Paramedics were conducted the MEND assessment on each stroke patient. The examination was conducted during patient transport to a stroke center in Jacksonville, Florida.  A neurologist observed the paramedic assessment via a HIPPA compliant cellphone application.  Following completion of the transmission, the neurologist completed a survey. A complete transmission was defined as a telemedicine encounter during which the exam was fully observed by the neurologist. 

Telemedicine transmission of field stroke assessments is a reliable method for stroke center physicians to gather information concerning neurologic deficits during field to hospital transport via ambulance. Transfer of this information during the pre-hospital phase of care may help to shorten DTN times. More widespread use of this telemedicine platform by rural emergency medical services could potentially help to improve outcome in rural residents with ischemic stroke who are treated with IT.