HAVE YOUR SAY

The final consultation paper, “Building a Future-ready Paramedic Workforce”, addresses core systemic issues and explores the following priority areas: Creating positive work environments; supporting diversity, inclusion and cultural safety in the workforce; supporting and engaging paramedics to work to their full potential; aligning capabilities (education, postgraduate and industry qualifications); and attracting and retaining the workforce.

Further stakeholder engagement will take place following collation of the feedback received on the consultation papers, and the College looks forward to bringing everyone within the profession along as we set out the future vision for paramedicine.

We encourage you to add your voice and provide feedback as we work together to collaboratively shape the future of paramedicine in Australasia - one that is representative of who we are now as a profession and how we will continue to evolve in the years ahead.

By Dr Angela Dos Santos

Successful ischaemic stroke treatment with thrombolysis or endovascular clot retrieval is heavily time-dependant. For every minute a stroke remains untreated, approximately two million neurons have died2

Health professionals are focused on treating patients as quickly as possible after the stroke symptoms and signs occur. The most important and critical time is the first “golden hour” after stroke onset. If a patient can be treated within this time frame, the chances of resolution of symptoms and complete recovery is very high3

To hasten treatment of stroke patients, Australia’s first and currently only Mobile Stroke Unit (MSU) has been in operation since 2017. MSUs are unique ambulances fitted with a CT-scanner and experienced stroke specialised multi-disciplinary team that allows assessment, imaging, and treatment prior to reaching the hospital4

There are roughly 30 MSUs globally across five continents.

Suspected stroke patients can immediately be loaded onboard for neuroimaging and eligible patients can be administered thrombolysis. Patients needing thrombectomy or neurosurgical intervention can be diagnosed in the community and transported directly to a specialised centre with these capabilities, bypassing the local hospital where necessary. This avoids the need for an additional inter-hospital transfer.

Many more trails have been published that support the use of Mobile Stroke Units and now in Australia, if you live in a Metropolitan city, being treated by an MSU is regarded as best practise and has been incorporated into the Australian stroke clinical guidelines as level 1 evidence6

However, not all patients that experience a stroke live in metropolitan Australia, hence innovative solutions are needed to increase the number of patients that can be treated in the prehospital setting and “golden hour”. If this were possible, it would significantly reduce the number of stroke patients with lifelong disability.

One of the first clinical trials with an MSU in 2012 demonstrated reduced time from MSU dispatch to thrombolysis by a median of 41-minutes (35 vs 76 minutes, p<0.0001) compared to if they had arrived in the emergency department via ambulance5

One avenue being explored is the possibility of Stroke Smart Ambulances. A standard ambulance, with an imaging device capable of differentiating the stroke type and allowing the team onsite, with specialist neurologist support via telehealth using the Zeus Platform (www.titanneuro.com/zeus) to treat accordingly.

Electromagnetic imaging, in the microwave frequency band, is an emerging technology which promises to provide rapid and non-invasive neuroimaging at the point-of-care. Due to its portability, utilisation of non-ionising energy and the ongoing miniaturisation of the systems being developed by Australian medical device company EMVision, it is now being trialled to support the on-scene evaluation of time sensitive medical emergencies such as stroke and with plans to assess traumatic brain injury.

Electromagnetic imaging, in this work in the 500 MHz – 2 GHz range, looks at the dielectric properties (permittivity and conductivity) of different tissue types, including healthy tissue and lesions.

Earlier experimental data in animal models has shown that the dielectric permittivity of haemorrhagic brain tissue is increased by 10–20% compared to healthy tissue, while in ischaemic tissue it is reduced by 10–20% compared to healthy tissue7 EMVision with their own unique techniques have demonstrated in a proof-of-concept study conducted at the Princess Alexandra Hospital in Brisbane with 50 confirmed stroke patients, an ability to recognise lesions and differentiate between ischaemic or haemorrhagic nature8

The EMVision technology is currently undergoing hospital trials at major comprehensive stroke centres with a larger sample size of suspected stroke patients.

The first-generation cart-based version of the technology that is the subject of these trials, can be operated by any healthcare professional with the appropriate training, and has potential applications in stroke wards, ICUs and remote communities.

Next year, a lightweight (<10 kg) second generation helmet version of the technology (pictured left), designed to be deployed at the scene by paramedics, with images transmitted via the Zeus telehealth platform to clinicians, is scheduled for road and air ambulance trials.

With the Australian Stroke Alliance leading the way, the ambition of the EMVision technology is to support earlier triage and transfer decisions, helping identify those patients that may meet surgical criteria, so they can be taken directly to a comprehensive stroke centre, alongside opening the door to earlier tPA treatment for eligible patients, potentially saving millions of brain cells and reducing the impact of one of the leading causes of disability globally.

1. (Tan 1. E et al. The economic and health burden of stroke among younger adults in Australia from a societal perspective. BMC Public Health. 2022;22).

2. (Saver JL. Time is brain--quantified Stroke. 2006;37(1):263-6).

3. (Ma H et al. Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke New England Journal of Medicine. 2019;380(19):1795-803)

4. (Fassbender K et al. Mobile stroke units for prehospital thrombolysis, triage, and beyond: benefits and challenges Lancet Neurol. 2017;16(3):227-37).

5. (Walter S et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol. 2012;11(5):397-404.

Australian Stroke Alliance Fellow, Dr Angela Dos Santos is a proud Kwiamble and Gumbaynggirr woman and Australia’s first Aboriginal neurologist. Angela is a key clinical expert for the Alliance’s aeromedical prehospital retrieval plans, is co-chair of their Aboriginal and Torres Strait Islander Leadership Council, and is a member of their Pre-hospital Stroke Council. Her doctoral research is focused on stroke in Aboriginal and Torres Strait Islander Australians.

The Australian Stroke Alliance have partnered with EMVision Medical Devices Ltd and aims to provide portable, non-ionising, rapid neuroimaging for prehospital and bedside stroke evaluation.

6. (Stroke Foundation. Clinical Guidelines for Stroke Management. Available at https://informme.org.au/ guidelines/living-clinical-guidelinesfor-stroke-management. Accessed [30th June 2023]).

7. (Semenov SY, Corfield DR. Microwave tomography for brain imaging: feasibility assessment for stroke detection. Int J Antennas Propag. 2008; 2008:1–8.)

8. (Cook D, Brown H, Widanapathirana I, et al. Case report: Preliminary images from an electromagnetic portable brain scanner for diagnosis and monitoring of acute stroke. Front Neurol. 2021; 12:765412.)