FaceTime video has been one of the fundamental tools since 2014 in which Memorial Healthcare System began working with South Florida Fire Rescue EMS agencies in Miramar and Hallandale Beach, FL, to obtain valuable patient information that has enabled acute stroke teams at Memorial Regional Hospital, Hollywood, FL, and Memorial Hospital West, Pembroke Pines, FL, to be ready when stroke patients arrive to the Emergency Room.
Harnessing the features of FaceTime has been the brainchild of Brijesh P. Mehta, MD, a NeuroInterventional Surgeon at the Memorial Neuroscience Institute and Director of Stroke and Neurocritical Care, who says timing is everything, particularly when a large vessel stroke occurs.
“The longer neurons are deprived of oxygen due to a clot in the major arteries supplying blood flow to the brain, the more damage occurs,” said Dr. Mehta. “FaceTime is enabling us to evaluate patients while still in the ambulance en route to our hospital and to subsequently mobilize our teams for conducting brain imaging in the ER and subsequently performing mechanical thrombectomy in the cath lab, which has been shown to be highly effective in severe strokes. This revolutionary treatment offers a much wider time window for successful outcomes than traditional clot-busting drugs that must be delivered intravenously within 4.5 hours of stroke onset and are generally only effective in blockages of smaller vessels.”
Dr. Mehta said Memorial Healthcare System FaceTime allows audio and video capability to detect difficulty with speech, paralysis and fixation of the eyes in stroke patients — which are strong indicators for presence of a large vessel occlusion in the brain — and to subsequently prepare the cath lab team at the receiving hospital.
“Obtaining the necessary imaging and getting the patient to the cath lab can be very time-consuming,” said Dr. Mehta. “With the use of FaceTime, however, we have the potential to reduce our time to treatment to less than an hour from time of patient arrival to the ER, which often can be a lifesaver for a large artery stroke patient. The data shows that for every minute that lapses in a stroke, 2 million neurons are at risk for irreversible injury. Time is brain.”
How FaceTime Works
When Miramar and Hallandale Fire Rescue paramedics encounter a patient with stroke-like systems, they evaluate the individual according to stroke criteria based on the Rapid Arterial Occlusion Evaluation (RACE) scale.
“When the RACE score is 5 or greater — indicating a probable large vessel stroke — we immediately call Dr. Mehta, no matter what time of day or night it may be,” said Randy Gonzalez, Division Chief EMS at Miramar Fire Rescue.
Using FaceTime video, Dr. Mehta and the paramedics conduct a clinical evaluation of the patient according to established protocols to determine the patient’s neurological condition, such as the presence of significant speech impairment and arm/leg weakness. When there is strong indication of a large vessel stroke, Dr. Mehta immediately activates the cath lab at Memorial Regional Hospital or Memorial Hospital West.
“With Dr. Mehta activating his team while we are in transit, the cath lab is setup in advance and eligible patients are rapidly taken to treatment,” Gonzalez said.
After several years into the pilot project, outcomes are already exciting, according to Dr. Mehta. “Our rationale for rapid treatment is supported by recent publication of landmark clinical research trials that identified mechanical thrombectomy as highly effective and safe compared to traditional medical management. No longer are we asking whether these stroke therapies are beneficial. The question now is how we can administer them quickly to ensure the best possible outcomes for eligible patients.”