Video support in ambulances – project receives SEK 1.5 million

The project, which is developing video support in ambulances to provide stroke patients with the right care faster, is led by Lars Rosengren, Professor of Neurology at Sahlgrenska University Hospital and director of Stroke Centre West.

The project is an initiative from Prehospital ICT Arena (PICTA) at Lindholmen Science Park; additional contributors are the University of Borås, Chalmers University of Technology (Electrotechnology) and ambulance care in Region Västra Götaland.

ViPHS – Video Support in the Prehospital Stroke Chain – studies how the possibility of providing a correct preliminary diagnosis in the ambulance, making decisions about the level of care and preparing emergency care at the hospital can be improved using video support. In the initial stage, the focus will be on treating strokes, but in the future it will be possible to use video support for a significantly greater number of conditions – accidents, for example. In ViPHS, real-time video is “streamed” from the ambulance to a regional on-call stroke center, where neurological experts assess the patient in consultation with ambulance personnel and a decision is made jointly about the most suitable course of action in the current case. 

Lars Rosengren describes the kind of problems video support can help solve.

“The quality of emergency care in the event of a severe stroke varies depending on where you live, since the time to treatment has to be short. The majority of strokes are milder and are best treated with clot removers, whereas more severe strokes are often due to a large clot that must be removed mechanically. Since clot removal can be provided at all hospitals, the ambulances drive first to the one that is closest; in the event the doctors there verify that there is a large clot, the patient is transported further on to Sahlgrenska where advanced clot removal can be performed,” Lars says.

“But the detour via the local hospital delays treatment by at least an hour, and often there is not time to start the clot removal – or, if it is administered, the effect is worse. The best thing for these patients would therefore be direct transportation to Sahlgrenska, without a detour, but this is a medical decision the ambulance personnel cannot make. 

“But by using video support, stroke experts at Sahlgrenska can support and assess how the ambulance staff takes the patient’s medical history and examines the patient, and afterwards make a well-grounded decision on direct transportation for clot removal, if necessary. Video support will therefore make emergency care of strokes more equitable,” Lars says.

The aim of the project is to produce documentation that could form the basis of a possible full regional introduction and procurement. This includes the technology being tested, work processes being designed, and the effects on the care providers involved being identified – all to enable the smoothest possible full introduction. The results will be made available through PICTA and the arena’s Metis Forum network, as well as other channels. In the initial phase of ViPHS, aspects such as technology and process were tested through full-scale simulations. In the phase that has now received funding, the project will gradually move to tests in selected ambulances in operation.

Professor Bengt Arne Sjöqvist is Program Manager of PICTA at Lindholmen Science Park, which collaborates with some 30 organizations from healthcare, the business sector and academia. He is also Professor of Practice in Healthcare Informatics at Chalmers University of Technology. Professor Sjöqvist talked about the plans for the years ahead in the project.

“In the first phase, we tested technology and work processes in simulated authentic patient cases. This taught us a lot, for example, about camera placement, how an examination with video support should be conducted and what we can expect from the impact on work processes and the like,” he said.

“With this under our belts, we’re now stepping out into reality – operational ambulances. The objective of the project is not for us as a project group to deliver complete solutions over the long term to organizations like VGR. Instead, we will create documentation so that a procurement, if any, and a full introduction can be done with the best knowledge possible concerning technology, organizational impact, and work processes. By carrying out the project as part of PICTA, the ambition is also to spread this knowledge to as many people as possible – we want a functional method to have as broad and as rapid an impact in healthcare as possible, and that not just in VGR,” he emphasizes.

Stefan Candefjord is a research assistant in Electrotechnology at Chalmers University of Technology, and also works at Medtech West. In his research, he studies subjects such as the different forms of clinical decision-making support in prehospital care. He observes that this form of decision-making support will impact prehospital care and also contribute to his research.

“I believe that video support will provide opportunities to improve assessment and care of stroke patients through increasing precision in decisions early on in the healthcare chain. The project could also open the door to possibilities of better assessing other patients, for example, taking decisions on where a patient who has suffered trauma – such as a traffic accident – should be transported,” Stefan says. 

“Consultation with experts can also improve opportunities for the best use of more advanced decision-making support and future diagnostic equipment in the prehospital environment, for example, microwave diagnostics for detecting internal bleeding, or self-teaching algorithms that calculate the likelihood of a serious injury or illness based on a weighted assessment of risk factors,” he concludes.

Facts:

• Approximately 25,000 people suffer strokes every year in Sweden; VGR alone deals with 4,000 cases.
• Slightly fewer than 10% of cases are due to severe cerebral infarcts as a result of a blood clot in a central artery in the brain.
• Approximately one quarter of these stroke victims die; of the survivors, approximately 30% will be dependent on lifelong assistance with daily tasks.
• Even in the group that is least affected, lingering problems are common.
• Apart from the great deal of suffering they causes, strokes are also the costliest illness in Sweden – around SEK 19 billion a year.