title: Mobile Telestroke During Ambulance Transport Is Feasible in a Rural EMS Setting: The iTREAT Study.
abstract: The use of telemedicine in the diagnosis and treatment of acute stroke, or telestroke, is a well-accepted method of practice improving geographic disparities in timely access to neurological expertise. We propose that mobile telestroke assessment during ambulance transport is feasible using low-cost, widely available technology.
  
  
  
  We designed a platform including a tablet-based end point, high-speed modem with commercial wireless access, external antennae, and portable mounting apparatus. Mobile connectivity testing was performed along six primary ambulance routes in a rural network. Audiovisual (AV) quality was assessed simultaneously by both an in-vehicle and an in-hospital rater using a standardized 6-point rating scale (≥4 indicating feasibility). We sought to achieve 9 min of continuous AV connectivity presumed sufficient to perform mobile telestroke assessments.
  
  
  
  Thirty test runs were completed: 93% achieved a minimum of 9 min of continuous video transmission with a mean mobile connectivity time of 18 min. Mean video and audio quality ratings were 4.51 (4.54 vehicle; 4.48 hospital) and 5.00 (5.13 in-vehicle; 4.87 hospital), respectively. Total initial cost of the system was $1,650 per ambulance.
  
  
  
  In this small, single-centered study we maintained high-quality continuous video transmission along primary ambulance corridors using a low-cost mobile telemedicine platform. The system is designed to be portable and adaptable, with generalizability for rapid assessment of emergency conditions in which direct observational exam may improve prehospital diagnosis and treatment. Thus mobile telestroke assessment is feasible using low-cost components and commercial wireless connectivity. More research is needed to demonstrate clinical reliability and efficacy in a live-patient setting.
authors.affiliation: 1 Department of Neurology, University of Virginia Health System , Charlottesville, Virginia.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Lippman
authors.affiliation: 2 Department of Neurology, Virginia Commonwealth University Health System , Richmond, Virginia.
authors.forename: Sherita N Chapman
authors.initials: SN
authors.lastname: Smith
authors.affiliation: 3 Department of Public Health Sciences, University of Virginia Health System , Charlottesville, Virginia.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: McMurry
authors.affiliation: 4 The Brody School of Medicine, East Carolina University , Greenville, North Carolina.
authors.forename: Zachary G
authors.initials: ZG
authors.lastname: Sutton
authors.affiliation: 5 Department of Center for Telehealth, University of Virginia Health System , Charlottesville, Virginia.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Gunnell
authors.affiliation: 1 Department of Neurology, University of Virginia Health System , Charlottesville, Virginia.
authors.forename: Jack
authors.initials: J
authors.lastname: Cote
authors.affiliation: 6 Department of Emergency Medicine, University of Virginia Health System , Charlottesville, Virginia.
authors.forename: Debra G
authors.initials: DG
authors.lastname: Perina
authors.affiliation: 5 Department of Center for Telehealth, University of Virginia Health System , Charlottesville, Virginia.
authors.forename: David C
authors.initials: DC
authors.lastname: Cattell-Gordon
authors.affiliation: 5 Department of Center for Telehealth, University of Virginia Health System , Charlottesville, Virginia.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Rheuban
authors.affiliation: 1 Department of Neurology, University of Virginia Health System , Charlottesville, Virginia.
authors.forename: Nina J
authors.initials: NJ
authors.lastname: Solenski
authors.affiliation: 1 Department of Neurology, University of Virginia Health System , Charlottesville, Virginia.|3 Department of Public Health Sciences, University of Virginia Health System , Charlottesville, Virginia.
authors.forename: Bradford B
authors.initials: BB
authors.lastname: Worrall
authors.affiliation: 1 Department of Neurology, University of Virginia Health System , Charlottesville, Virginia.|3 Department of Public Health Sciences, University of Virginia Health System , Charlottesville, Virginia.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Southerland
mesh_terms: D000552:Ambulances; D034201:Computers, Handheld; D006801:Humans; D019114:Remote Consultation / Q000191:economics / Q000295:instrumentation* / Q000458:organization & administration* / Q000592:standards; D015203:Reproducibility of Results; D012424:Rural Population; D013997:Time Factors
keywords: acute stroke; emergency medical services; mobile health; telemedicine; telestroke