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How is stroke retrieval changing?

4 Apr 2022

“For the first time in Australia’s history, the Stroke Alliance aims to close the health care gap in providing stroke care across our vast continent,” says Skye Coote (NP, CCRN, MN, NVRN-BC, ANVP-BC), the Alliance’s Senior Project Manager for Clinical Education. “The work of the Alliance will result in more patients with stroke receiving life-saving treatments and accessing world class stroke care.”

2 Skye Coote at MSU in 2021

Skye Coote.

Flight nurs­es’ abil­i­ty to improve stroke out­comes for rur­al and remote patients will soon improve, thanks to the Aus­tralian Stroke Alliance’s trans­for­ma­tion­al pre­hos­pi­tal retrieval program. 

The Stroke Alliance aims to shrink a typ­i­cal­ly 3‑tonne hos­pi­tal-based CT scan­ner into a small­er device so an air­borne emer­gency depart­ment can trav­el to the patient. The team is over­see­ing the design, build and inte­gra­tion of world-first, light­weight and portable brain scan­ners that will be placed into air ambu­lances, allow­ing faster diag­no­sis of stroke in any setting. 

As well, a tru­ly nation­al tele­health net­work will con­nect nurs­es, para­medics and coun­try doc­tors to city-based neu­rol­o­gists to speed up pre-hos­pi­tal stroke diag­no­sis and treatment.

The $40 mil­lion, fed­er­al­ly-fund­ed Stroke Alliance, incor­po­rat­ing 37 nation­al health and tech part­ners, is deter­mined to reach the eight mil­lion peo­ple liv­ing in rur­al and remote Aus­tralia who, through the tyran­ny of dis­tance, do not have access to fast stroke diagnosis.

Dri­vers of change

1 MSU Paramedics

MSU Para­medics.

Treat­ments for acute ischaemic stroke and haem­or­rhag­ic stroke are com­plete­ly dif­fer­ent and accu­rate diag­no­sis relies on an urgent brain scan. Access to a scan direct­ly influ­ences a patient’s time to treat­ment and their like­ly chance of survival.

Not only do rur­al and remote peo­ple have 20 per cent more strokes than those in urban set­tings, most have to trav­el more than 200km for help, dou­bling the like­li­hood of sig­nif­i­cant, life­long dis­abil­i­ty. Only three per cent receive care in a spe­cial­ist stroke unit com­pared to 77 per cent of peo­ple in metro settings.

The Alliance is also address­ing the dis­pro­por­tion­ate impact of stroke on First Peo­ples. Although they make up three per cent of the pop­u­la­tion, they rep­re­sent 16.5 per cent of Roy­al Fly­ing Doc­tor air retrievals for stroke.

What hap­pens next? 

From 2023, the scan­ners and tele­health plat­form will be test­ed and val­i­dat­ed in the clin­i­cal set­ting, pro­vid­ing an unprece­dent­ed lev­el of sup­port to first responders.

The Stroke Alliance is work­ing in close part­ner­ship with the nation’s ambu­lance author­i­ties and the Roy­al Fly­ing Doc­tor Ser­vice in prepa­ra­tion for a pilot study of the brain scan­ners. A com­pre­hen­sive edu­ca­tion pro­gram will pre­cede the launch of the devices to ensure first respon­ders are ful­ly informed and that their unique require­ments have been met.

The tele­health plat­form, known as Zeus, real­ly is the back­bone of the pro­gram. It has been designed by per­fu­sion imag­ing spe­cial­ist, Asso­ciate Pro­fes­sor Andrew Bivard and neu­rol­o­gist, Pro­fes­sor Mark Parsons.

The Zeus app is already being test­ed in the field and is per­form­ing exact­ly as antic­i­pat­ed on Melbourne’s mobile stroke ambulance.

Ear­ly in 2022, it will be installed in select­ed road ambu­lances in NSW and Vic­to­ria. Para­medics who have seen and test­ed the Zeus app have been impressed and are keen to see it as a stan­dard tool in the diag­no­sis of stroke.

How the tech­nol­o­gy works

3 The RFDS in Tanami Downs

The RFDS in Tana­mi Downs.

Zeus allows essen­tial clin­i­cal data to be shared with the receiv­ing hos­pi­tal, influ­enc­ing treat­ment deci­sions and increas­ing the safe and time­ly deliv­ery of medications. 

Some­times, that will mean the stroke ambu­lance needs to go past the near­est hos­pi­tal to reach a spe­cial­ist stroke cen­tre where an endovas­cu­lar team is prepped, ready to remove a clot from a blocked blood ves­sel. Accord­ing to Pro­fes­sor Par­sons: Get­ting the right patient to the right hos­pi­tal as quick­ly as pos­si­ble is critical”.

Based on the urban mobile stroke ambu­lance mod­el, researchers know Zeus and the use of a brain scan­ner in the vehi­cle may lead to ear­li­er treat­ment by up to two hours. Of course, the impact in rur­al and remote set­tings is yet to be mea­sured but it is antic­i­pat­ed that a brain scan at the site of the stroke will allow throm­bol­y­sis or oth­er treat­ment deci­sions to be made with­in minutes.

The impact of treat­ing even one hour ear­li­er pro­vides a stroke sur­vivor with more than one extra year of dis­abil­i­ty-free life.

As a result, instead of only being able to pro­vide sup­port­ive in-flight care, staff will admin­is­ter tar­get­ed, spe­cialised stroke treat­ments to their patients. They will be able to treat patients with throm­bol­y­sis, anti­hy­per­ten­sives, anti­co­ag­u­la­tion rever­sal agents, iden­ti­fy those patients need­ing spe­cial­ist stroke care and accu­rate­ly and con­fi­den­tial­ly triage stroke care in the pre-hos­pi­tal setting.

Cus­tomised fea­tures are accessed from a phone or web-brows­er with audio-visu­al assess­ment of a patient, phone cam­era and image shar­ing, region-spe­cif­ic patient assess­ment forms, pre-noti­fi­ca­tion for clin­i­cians, indi­vid­u­al­pa­tient record export, admin­is­tra­tor auto­mat­ic report­ing, and data col­lec­tion for analysis.

The Alliance invites pre-hos­pi­tal retrieval ser­vices to co-design the path ahead to ensure this ambi­tious ini­tia­tive takes off in 2023.

At the end of the day, the team wants to reduce dis­abil­i­ty and deaths from stroke. Inde­pen­dent analy­sis has cal­cu­lat­ed that some 45,000 dis­abil­i­ty-adjust­ed life years (DALYs) will be saved over 30 years through the Aus­tralian Stroke Alliance’s interventions.

This project is an ini­tia­tive of the Aus­tralian Stroke Alliance, bring­ing togeth­er 37 organ­i­sa­tions com­mit­ted to improv­ing urgent pre-hos­pi­tal stroke care across the nation. To find out more or to con­tact the Aus­tralian Stroke Alliance, vis­it www​.aus​trokeal​liance​.org​.au. The Aus­tralian Stroke Alliance is an ini­tia­tive of the Aus­tralian Government.