A new mobile telemedicine project in Virginia will give physicians and paramedics the ability to diagnose stroke patients before they reach the hospital, enabling more patients to receive the clot-busting drug tissue plasminogen activator, or tPA, sooner on arrival.

tPA is effective only if administered within three hours of symptom onset. Currently, because of transport delays and time-to-diagnosis, less than 5 percent of stroke patients receive tPA.

The University of Virginia Health System project called Improving Treatment with Rapid Evaluation of Acute stroke via mobile Telemedicine — iTREAT — employs a secure video link to connect paramedics to the hospital's stroke neurologists, who can begin diagnostic protocols while patients are being transported.

"iTREAT will allow real-time visual communications between EMS providers and neurologists so that history and pertinent neurological physical exams can be done remotely while patients are en route to the hospital," says Debra Perina, M.D., professor of emergency medicine and division director of prehospital care at the University of Virginia School of Medicine.

The goal is to shorten the time from onset of stroke symptoms to provision of tPA and other treatments as indicated. "Currently, the team needs to wait for patients to get to the hospital to do this face-to-face," she says.

The health system and the Thomas Jefferson Council for Emergency Medical Services are equipping 12 ambulances in four Virginia counties with iTREAT toolkits, which include tablet devices, secure videoconferencing technology, high-speed modems and magnetic antennas to mount on top of the vehicles. Estimated cost per ambulance is $5,000.

Additional EMS training is not expected to be an issue because EMS personnel already are trained to recognize symptoms of stroke and to perform the Cincinnati Prehospital Stroke Scale on those who exhibit stroke symptoms. "The only training needed for iTREAT for the EMS providers will be on the equipment and protocols set up for contacting the neurologist," says Stephen Rea, executive director of the Thomas Jefferson EMS Council.

Rea says that while stroke patients represent less than 2 percent of EMS calls in the council region, 22.65 percent of EMS calls involve patients with symptoms that mimic stroke. "This is why it is essential that EMS providers are educated about differential diagnosis," Rea says. "iTREAT can be a tool for providers to treat patients more appropriately."

Perina says that if iTREAT demonstrates utility for facilitating more rapid stroke treatment, it potentially could be expanded to enhance treatment of such other time-sensitive, life-threatening conditions as heart attack, trauma and sepsis.