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

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

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.