Feb. 6, 1998 Doctors at the University of Maryland Medical Center are the first in the nation to use sophisticated video and computer technology to assess a stroke patient's condition during an ambulance ride, before arrival at the hospital. Two Maryland Express Care ambulances have been outfitted with digital cellular equipment that allows neurologists in their hospital office to see a stroke patient in real time video and speak to the emergency medical personnel on the ambulance as they rush the patient to the hospital.
"Every moment counts, now that we have a drug to dissolve clots causing the stroke. If we can save time and get a head start in evaluating patients even before they arrive at the hospital, we may be able to prevent more death and disability," says Marian LaMonte, M.D., director of the Brain Attack Team at the University of Maryland Medical Center.
In addition to allowing doctors to see the patient's neurological symptoms, the new "TeleBAT" program (named for the Brain Attack Team) also allows the transmission of a blood analysis from two drops of a patient's blood during the ambulance ride. In addition, the patient's vital signs, including an EKG, are transmitted to the doctor's computer screen at the hospital.
Dr. LaMonte presented results of early testing of the system at the American Heart Association's 23rd International Joint Conference on Stroke and Cerebral Circulation on February 5 in Orlando.
"By having this information ahead of time, before the patient arrives at the hospital, we hope to shave about 20 minutes off of the evaluation time. That is very important considering that we only have a three-hour window from the time stroke symptoms begin to administer the clot-busting drug, Activase," says Dr. LaMonte.
"Our preliminary findings indicate that the system will be useful in patient diagnosis and care," adds Dr. LaMonte.
The mobile telemedicine project is funded by a $500,000 research grant from the National Library of Medicine. The system was developed by the University of Maryland and BDM International, an information technology and systems integration firm based in northern Virginia.
The prototype hardware cost about $27,000. It includes two computers to run the system and four digital cellular telephones. The digital phone service is provided by Sprint Spectrum. Technology that enables images to be sent from a moving vehicle by cellular telephones came from Fonet, the first company to develop such technology.
"The system we have developed provides a lot of flexibility," says Yan Xiao, Ph.D., an assistant professor of anesthesiology at the University of Maryland School of Medicine who has coordinated the project. "We have set it up so that a physician can interact with emergency personnel and patients on two or more ambulances at the same time. Also, the physician can log on to any computer with an internet connection to use the technology. That means there will be no unnecessary delay in starting to evaluate a patient who is being rushed to the hospital," says Dr. Xiao.
"This new, sophisticated system is just the first step in helping medical professionals save the lives of patients with time-sensitive interventions," says Colin F. Mackenzie, M.D., professor and vice chairman of anesthesiology at the University of Maryland Shock Trauma Center. Dr. Mackenzie is the principal investigator of a study funded by the U.S. Department of Defense to study practical applications of telemedicine for trauma patients .
"For example, this technology may help trauma patients who need insertion of a tube into the windpipe to maintain breathing and oxygenation even before they reach a hospital," says Dr. Mackenzie. Paramedics would have the help of trauma doctors to guide them during the ambulance ride as they stabilize a patient. The system would also help trauma centers prepare to receive patients before they arrive at the front door.
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