TeleBAT: mobile telemedicine for the Brain Attack Team

TeleBAT is our application of an integrated mobile telecommunications system (MTS) to the clinical problem of acute stroke. Although efforts are ongoing to educate patients to seek emergency treatment at the first signs of stroke, we sought to shorten time to treatment once the patient is known to the emergency medical system. Ambulance paramedics acquire valuable assessment data about a stroke patient en route to a medical center. We tested the feasibility of using wireless digital cellular communication to provide a stroke neurologist with real-time visual access to the neurological examination of patients conducted during transport to our stroke treatment center. Audio and visual information, and patients vital signs were transmitted from our interfacility ambulance. The MTS was designed to be user-friendly and includes turnkey operation inside the ambulance and flexible access through a internet browser by the clinicians in the hospital. With 4 simultaneous cellular phone connections, each with a bandwidth of 9.6 kilobytes per second, the throughput was a 320x240-pixel image every 2 seconds. The image quality requirement was determined through empirical testing by using a videotaped National Institutes of Health Stroke Scale examination. A framework to assess adequacy was developed and defined as the ability of the clinician to make an identical clinical judgment when visual access to the patient was provided by either audio-visual transmission or by face-to-face examination. We have shown mobile telemedicine linking prehospital providers with a stroke center neurologist and thus have come one step closer to transforming the prehospital phase of transport to prehospital phase of treatment.