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When minutes matter: Hospital, ambulances using video to put doctors in rig with stroke patients

By GRETCHEN M. GROSKY
New Hampshire Union Leader

July 12. 2017 4:31AM
Dr. Amanda Avila is seen on a video monitor during a demonstration of the TeleStroke Ambulance Program at Catholic Medical Center in Manchester on Tuesday. (DAVID LANE/UNION LEADER)
Signs of stroke
Call 911 immediately if you observe any of these symptoms:

• Sudden numbness or weakness of face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Source: U.S. Centers for Disease Control and Prevention

A tablet attached to the ambulance door provides the video link between neurologist and patient in the TeleStroke system demonstrated Tuesday at Catholic Medical Center. (DAVID LANE/UNION LEADER)

MANCHESTER — When it comes to a stroke, minutes matter. Wait too long and it could mean irreversible brain damage, paralysis or death.

To improve outcomes for stroke patients, Catholic Medical Center is partnering with local ambulance providers to use video conferencing so a neurologist can evaluate patients en route to the hospital.

“Assessing patients as quickly as possible is vital in the treatment of those experiencing stroke-like symptoms,” said Dr. Nima Mowzoon, CEO of TeleSpecialists, which is providing the TeleStroke service. “Once we receive the call, we can have a neurologist on screen, or in this case a tablet, evaluating a patient within minutes.”

Mowzoon, a neurologist, said a neurological assessment in the ambulance can shave more than 15 minutes of in-hospital evaluation time and get helpful treatments to patients faster.

“With strokes, time is ticking for patients,” Mowzoon said Tuesday.

The first 60 minutes after showing signs of a stroke are referred to by doctors as the “golden hour.” In cases of ischemic strokes caused by clots in the brain, one in every three patients will see major improvement if given the clot-busting treatment tissue Plasminogen Activator (tPA) within three hours of the first symptoms, according to the American Academy of Neurology.

The U.S. Centers for Disease Control and Prevention estimates 795,000 Americans will suffer a stroke each year and 130,000 will die from one.

For those who survive, the damage can cause a host of problems, including paralysis, memory loss and speech problems. Strokes are the leading cause of serious long-term disability in the United States, costing an estimated $33 billion each year, according to the CDC.

“Time is muscle when it comes to strokes,” said Nick Mercuri, chief of strategy and planning for New Hampshire Fire & EMS. “The goal is to get treatment faster to the patient because it can reduce the damage done by strokes.”

TeleStroke is now being used in seven AMR ambulances operated by AMR and in Goffstown Fire and Peterborough Fire department ambulances. Mowzoon and CMC officials said they expect many more ambulances to be outfitted with the technology soon.

Peterborough Deputy Fire Chief Joshua Patrick said his department serves six rural communities that are an hour away from Catholic Medical Center. He said they have had a tablet in the ambulance for a month and already used it twice.

Goffstown Fire Chief Richard O’Brien said his department has been training with TeleStroke for weeks and used it once in the last month. He said his department is already using similar technology with cardiac patients.

Both chiefs said there has been one hiccup in the program — inconsistent cellular service, causing tablets to lose signals in rural areas.

“The cell signal isn’t always the best,” O’Brien said. “We’re working on that.”

The use of telemedicine in ambulances is not really a new concept, said Lu Mulla, vice-president of clinical and emergency services for Catholic Medical Center.

Mulla said the hospital started years ago using Blackberry devices to transmit EKG results from ambulances to hospital cardiologists; that program has evolved into using video and tablets. She said it made sense to bring the same technology to stroke patients.

“It’s a quality of life thing. It could be the difference between someone spending their life in a wheelchair or walking again. It could be the difference between life and death,” Mulla said. “For the EMTs, it’s important to have that physician in the rig with you.”

Union Leader reporter Gretchen Grosky regularly covers issues related to aging, and welcomes suggestions from readers. She can be reached at ggrosky@unionleader.com or (603) 206-7739. See more at www.unionleader.com/aging.


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