Background
Prehospital evaluation of suspected stroke patients has the potential to accelerate reperfusion therapies. However, international experience has generated conflicting results. These systems aim to identify patients in the pre-hospital setting with stroke who may benefit from hyper-acute therapies, determine eligibility for these therapies, and pre-notify the receiving hospital. We hypothesised that pre-hospital telehealth assessment with PULSARA in the Gippsland region to gather patient information prior to hospital arrival would improve the proportion of patients receiving timely stroke care.
Methods
This quality assurance project of the PULSARA pre-hospital stroke program will run for 6-12 months across 5-rural hospital sites in Gippsland. This program entails paramedic-initiated communication to a stroke clinician via PULSARA for all suspected stroke presentations. The stroke clinician assess to distinguish stroke from mimics, confirms pre-morbid function, last-known-well time and thrombolytic contraindications via video-call, which is then transmitted to the receiving hospital. Primary outcome is improved median door to CT compared to the pre-intervention period.
Results
Since activation in December 2025, 21 patients have been reviewed, with a median age of 74.0 (interquartile range 53.0-77.0) with 10 (47.6%) females. Victorian Telestroke Service was activated in 13/21 (61.9%), with 6/13(46.2%) receiving a diagnosis of ischaemic stroke, of whom 2 received intravenous thrombolytic therapy, and 1 was transferred for endovascular therapy.
Conclusion
Pre-hospital telehealth assessment to identify patients with potentially treatable stroke and pre-notify receiving hospitals is feasible and has potential to improve the proportion of patients receiving timely stroke care. Updated results will be available for the conference.