South East Coast Ambulance Service NHS Foundation Trust and East Kent Hospitals University NHS Foundation Trust

In November 2018, a telemedicine pilot was set up between South East Coast Ambulance Foundation Trust and East Kent Hospitals University Foundation Trust to test the feasibility of pre-hospital direct calls between ambulance clinicians and hospital Doctors in order to triage patients who are FAST+ (Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services).

The pilot wanted to find out if triaging patients for FAST+ in the ambulance or patient’s home would reduce the number of stroke mimics being conveyed past their local Emergency Departments unnecessarily. It also wanted to find out if early triage by a stroke consultant could potentially speed up ‘door-to-needle’ times once patients were at hospital by enabling better preparation.

A secure link was set up on FaceTime (via iPad) between South East Coast Ambulance Service NHS Foundation Trust staff based in Thanet and East Kent Hospitals University NHS Foundation Trust consultants in two hospitals. The pilot ran for 5 hours each evening over a 2-week period.

The pilot showed that telemedicine can substantially reduce door-to-scanner time by preparing the hospital team before the arrival of the patient. However, long connection times and some poor-quality images were issues that needed to be addressed prior to adoption.

During the COVID-19 pandemic, rapid adoption of FaceTime to 24/7 stroke consultants in hours and neurology registrars out of hours for all stroke patients has been implemented.in order to protect potentially vulnerable patients from unnecessary journeys.

Anecdotal feedback from the pilot suggests the project reduces Emergency Department attendances, enhances pre-hospital patient care and is widely accepted by both health care practitioners and patients. SECAmb are currently exploring the option of using GoodSAM as a longer term telemedicine platform, and the stroke team at East Kent are seeking a grant extension to continue this project.’

Dave Sherwood, Assistant Director of Patient Care at South Central Ambulance Service NHS Foundation Trust, who had a Stroke in September 2017 shares his experience;

On the 14^th September 2017 Dave started his normal day feeling fine and went to work. He soon had visual disturbances which turned into sickness after 30 minutes. He checked his blood pressure and found it was high so went to Royal Hampshire County Hospital, Winchester. Within 10minutes of arrival at hospital Dave felt a burning sensation in his head and a tingling heat sensation shot down the left side of his body, leaving him unable to speak, or move his arm.

Dave Sherwood said; “I felt the most vulnerable I have ever felt at any time in my life, something that will never leave me, from being a confident outgoing individual to not being able to talk or move in seconds and being fully aware of my surroundings. I was discharged from hospital the following day, proving I could shave and get myself to a downstairs toilet.

My left arm needed physio to rebuild the strength but my left leg was very painful, like a tooth ache, and took at least five months to return to spontaneous movement. All this was hard work to recover I spent 2hrs a day in the gym with a stroke rehabilitation trained gym instructor and Pilates class to strengthen limbs and core”

Dave is now back at work full time and has full function, living a full and active life all thanks to the rapid treatment he received from South Central Ambulance Service NHS Foundation Trust and the stroke team at Royal Hampshire County Hospital, Winchester.

David Sherwood continued; “Apart from the emotional changes that are there to constantly remind me of my vulnerabilities, which is probably a good thing, I wish every stroke sufferer could have the same outcome as me and although I am proud to be a stroke survivor I feel guilty at times that I have recovered so well. If we can ensure a safe and quick response and limit the time on scene to get patients to the stroke units as quick as possible then I hope we can give all our patients the same chance I was given”

Notes

Raj Thakkar is a GP at the Bourne End and Wooburn Green Medical Centre in High Wycombe. He is also Clinical Commissioning Director for Buckinghamshire Clinical Commissioning Group and Primary Care Cardiology lead for the Oxford Academic and Health Scientific Network. Dr Thakkar makes regular broadcast appearances and is willing to be interviewed.

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