Excellence in Patient Care The Case for Prehospital Telestroke

Wellington Free Ambulance

Team: Melissa Robinson, Dr Andy Swain

Interhospital telestroke has been used in New Zealand's Central Region to allow Wellington stroke physicians to provide remote assessment and care to acute stroke patients presenting at other hospitals since 2016. It has been shown to increase reperfusion rates and reduce door-to-treatment times. In 2019-2020, Wellington Free Ambulance (WFA) participated in a pragmatic, community based, cluster randomised controlled trial with the University of Otago. This study applied telestroke to the prehospital environment and showed that it was safe, highly accurate and achievable. It provided strong evidence to support all frontline ambulances in the Wellington Region becoming mobile telestroke units (MTUs) providing an opportunity to build a model of care that crosses traditional organisations/sector boundaries.

The MTU system has opened opportunities for further enhancements to stroke care and reduced the time to reperfusion for these patients. Further studies are planned to evaluate the outcome from these improvements and build a system that brings together the efforts of ambulance and hospital staff to the benefit of stroke patients.

Key aims of the project include:

• Implementation of a prehospital telestroke system (MTUs)

• Improvement in diagnosis and exclusion of patients with stroke mimics

• Direct transfer of patients to computed tomography (CT)

• Paramedic access to specialist medical guidance to improve stroke care

• Enhanced education for paramedics

• Establishment of a district hospital bypass system for likely SCR patients.