Evaluating the Impact of a System-Wide Prehospital Teleconsultation on Rural Stroke Transportation Efficiency

Geographic disparities in urban-rural stroke outcomes are in part due to limited and delayed access to reperfusion therapies such as endovascular thrombectomy. This study evaluated the impact of a prehospital telephone consultation on transportation patterns and efficiency for rural patients with suspected large vessel occlusion stroke.

This retrospective cohort study utilized administrative data from consecutive patients in Alberta, Canada, who underwent an emergency medical services-initiated rural field consultation for suspected acute stroke with a Los Angeles Motor Scale score of ≥4 between April 2017 and March 2023. The impact of field calls on transport efficiency was quantified using a novel metric: the Stroke Speedometer, calculated as the distance from the emergency medical services origin to the final destination (in kilometers) divided by the travel time (in hours).

Of the 704 included rural field consultations, 476 patients (67.6%) were directly transported to a comprehensive stroke center, 192 (27.3%) to a primary stroke center, and 36 (5.1%) to a nonstroke center. Direct transport to a comprehensive stroke center was associated with a significantly faster Stroke Speedometer (53±18 versus 44±24 km/h; P<0.001), younger patient age (median, 74 years versus 78 years; P=0.005), and increased likelihood of endovascular thrombectomy (adjusted relative risk, 2.25 [95% CI, 1.44-3.50]) compared with initial transport to a noncomprehensive stroke center hospital.

A prehospital telephone consultation (ie, rural field call) is feasible and helps identify and facilitate direct transport of rural patients with suspected large vessel occlusion to an endovascular thrombectomy-capable comprehensive stroke center. These findings highlight the value of integrating real-time, neurological consultation early into prehospital workflows to overcome the geographic and logistical barriers that contribute to rural-urban disparities in stroke care. The Stroke Speedometer metric represents a novel approach for assessing and enhancing prehospital stroke logistics.