The Scottish Highlands are beautiful: snow-topped mountains rolling down to deep blue lochs. The peace is untroubled by the widely dispersed population; it is rural tranquillity at its most spectacular, idyllic. But what happens when you need urgent medical care in such a remote location – in the wake of a stroke, for example?
Getting to remote areas is no walk in the park for emergency services. But a new project based at Aberdeen University’s Centre for Rural Health is aiming to reduce diagnosis and treatment times, using satellite and mobile networks to transmit ultrasound images from ambulances to experts. This could improve stroke outcomes in areas that can be hundreds of miles away from centres of diagnosis and treatment.
Guidelines say that stroke patients who have a blockage (or thrombosis) in the vessels in their brain should ideally receive a “clot-busting” thrombolytic injection within 90 minutes of the onset of the stroke, or at most within four and a half hours. This increases the patient’s chances of recovering with less disability.
Around 85-90% of strokes are as the result of blockages, but 10-15% are a different type of stroke – a bleed or haemorrhage in the brain. If this is the case, then giving them the clot-busting treatment can make the problem significantly worse. It is therefore vital that the type of stroke is determined before any treatment is given.
This is where our Satellite Ultrasound for Rural Stroke project comes in. We are investigating the use of ultrasound machines in ambulances so that diagnosing blockages or bleeds can begin as soon as paramedics reach the patient. Currently only a tiny percentage of rural patients receive the right treatment within the optimal timeframe and there is considerable room for improvement. In fact, every fifteen minutes of delay counts when it comes to treating stroke patients.
Scanning on the scene
When stroke patients are taken to hospital they would normally be given a scan of their brains to identify what type of stroke they are suffering from, then be treated accordingly. While it isn’t generally feasible to transport these bulky, complex scanners, there is a less expensive, portable alternative called transcranial ultrasound. This equipment can be carried in ambulances to the scene of the emergency and scans performed by paramedics. We’ve now developed a way of streaming the live images of a patient’s brain back to an expert in hospital to review and provide advice about the next stage of care.
To transmit the images, the project uses an Omni-Hub™. This device grabs whatever mode of communication is available in that location at that time – whether it’s 2G, 3G, 4G, Wi-Fi or two types of satellite – to ensure the information is safely transmitted directly to the expert’s terminal.
So far, we’ve successfully tested out this new system in the Scottish Highlands. We were able to beam ultrasound images from an ambulance via a central control facility in Leicestershire back to an expert’s iPad in Inverness, with only a small delay of a second or two. Our next step is to test the equipment on healthy volunteers to prove the process is feasible, before moving on to working with stroke patients, comparing portable transcranial ultrasound with the current standard care.
All going well, this technology can be adopted more widely. For example, there is potential for it to be used to assess injuries in rural road accidents and abdominal pain in isolated locations such as oil rigs. As a simple and cheap way of gathering images outside of hospitals, ultrasound has a wide potential given back-up from experts and some smart communications technology to connect the two.