ViPHS: Video Support in the Prehospital Stroke Chain
ViPHS has its foundation in the PrehospIT-Stroke project; it involves various types of video support in the prehospital stroke medical care chain.
Recommendations for suitable video solutions were prepared as part of PrehospIT-Stroke. These will be tested and evaluated as part of ViPHS, with the goal of achieving routine clinical practice. ViPHS is divided into the three subprojects below.
1) ViPHS Ambulans will support video consultation between ambulances and stroke experts, and is built on a permanently installed camera in the ambulance. Implementation of the subproject is planned in three steps:
I. technical and user tests and evaluation using realistic simulation experiments
II. limited testing and evaluation in a clinical operating environment
III. introduction as a matter of routine
Step 1 in ViPHS Ambulance has been granted funding from the Innovation Fund in VGR, and is led by Professor Lars Rosengren, VGR/SU. Besides PICTA and VGR/SU, those participating in the project are the University of Borås, Skåne Region and the ATC (Ambulance Training Center) at Skaraborg Hospital.
2) ViPHS Mobile is a portable solution that will support video consultation between prehospital staff in a home environment, for example, and a stroke expert. Implementation of the subproject is planned in three steps, in the same manner as ViPHS Ambulance. A degree project in partnership with Signals and Systems at Chalmers University and MedTechWest began in the spring of 2017 with a focus on Step 1; it was managed by Bengt Arne Sjöqvist and Stefan Candefjord and run in partnership with the University of Borås.
3) ViPHS BOST (By-Stander Online SupporT) is a smartphone solution that will support video transfer between, for example, a family member and an emergency response center, an ambulance in transit or other recipient. Implementation of ViPHS BOST is planned in stages, in the same manner as the projects above.
- Stroke affects approximately 25,000 people each year in Sweden – around 4,000 in the VGR region alone. About 20% of those affected die and approximately 30% become functionally dependent. The remaining 50% are deemed “functionally independent” but this group can have lifelong milder neurological disorders.
- Stroke is the most expensive somatic illness in Sweden; the annual costs are estimated at around SEK 19 billion.
- The most important factor for the outcome of stroke treatment through thrombolysis (drugs that dissolve minor blood clots), and thrombectomy (where larger blood clots are mechanically drawn out) is the time needed until the circulation of blood in the brain has been restored. In VGR and northern Halland, for example, SU/Sahlgrenska is the only hospital where thrombectomies can be performed.
- This means that if a decision on thrombectomy can be made early on in the healthcare chain, 1–2 hours can be spared for recanalization (restoring flow to blocked vessels), on a patient who is transported directly to SU/Sahlgrenska for thrombectomy, instead of first being brought to a hospital closer by where this is not performed.
- At the same time, if a patient who is suitable for thrombolysis is brought to SU/Sahlgrenska instead of the hospital closer by, important time for recanalization is lost due to longer transportation times.
- Through video support and the regional stand-by stroke service in VGR, there is always a neurological expert available to consult with the ambulance staff on the patient’s symptoms and decide on where the patient should be transported, as well as suitable initial treatment.
- Video communication with stroke doctors and the regional stand-by stroke service provides better quality in prehospital assessment. The technology provides many benefits such as support if the stroke alarm should be triggered or called off, or support in complicated cases.