Chilton docs 'beamed in' to stroke patients in ambulance

A new Star Trek-type device allows Chilton Medical Center paramedics to “beam” a neurologist into an ambulance to examine and direct treatment for a stroke patient.

When called to a scene by EMT Basics, the paramedics can jump into a municipal ambulance with an InTouch Health Xpress, a Skype-like telemedical device with a pan-tilt-zoom camera that uses WiFi or cellular broadband.

Once a neurologist is called on his or her desktop, laptop, iPad or iPhone, the doctor’s image will appear on the device’s monitor.

“This technology allows me to rapidly evaluate and treat a person who’s having a stroke before they even get to the emergency room,” said Dr. Robert Felberg, medical director of the Comprehensive Stroke Center for Atlantic Neuroscience Institute at Overlook Medical Center.

“It cuts about 16 minutes off the time it takes to treat a stroke, which is the equivalent of around 32 million brain cells,” he said. “This equipment means the difference between spending the rest of your life at home, talking to your family, and spending the rest of your life in a nursing home in a wheelchair with a feeding tube.”

When called, a doctor can be anywhere, except an airplane, and swing into action.

“I can be in my truck,” Felberg said. “I’ve taken command control of an ambulance while I’m at restaurants. I’ve done it while giving lectures.”

Eight so far

As of July 1, the day the new tech went into use at Chilton, eight stroke patients have benefited from it, according to Lynn Squillacote, coordinator of the the medical center’s stroke program.

The innovation follows Chilton’s January 2014 merger with Atlantic Health System, which includes Morristown Medical Center, Newton Medical Center, and Overlook Medical Center, home to the Atlantic Neuroscience Institute.

At the time of the merger, Atlantic agreed to invest $65 million in IT and capital improvements at Chilton, according to Modern Healthcare, which reports healthcare business and policy news.

There are four InTouch Health Xpress machines in use at Atlantic —two at Overlook, two at Chilton, according to Anna Scalora, Chilton spokesperson. Since Chilton services patients as far north as Hewitt in West Milford (Passaic County), a 30-minute ride from the medical center, the technology is needed.

“Shortening that time where diagnosis can begin and treatment can start can mean life and death,” she said.

Kathy Ratchko, paramedic and coordinator with Atlantic Ambulance, a Livingston-based fleet of 150 vehicles, described exactly how the unit saves time, starting with turning the unit on, to warm it up, before the patient is even in the ambulance.

“We prep the patient in advance,” Ratchko said. “We tell the patient, ‘We’re going to have a consultation with a stroke doctor. This is his specialty. You can talk to him. He will be able to talk to you. If you have any questions, please ask him.’

“Next, we hear the doctor beam in, just like in ‘Star Trek,’” she said. “That’s why we call it beaming in.”

Connecting to ER

Just as the neurologist on the monitor, also known as a teleneurologist, directs the paramedics in how to treat the patient, he simultaneously connects with the ER so it can prep for any procedure the doctor wants done. Any informed consent required to do the procedure is gotten from the patient in the ambulance.

“It’s great to have the consultation already done by the time we arrive at the hospital,” Ratchko said. “We don’t have to put the patient in a room and repeat our story multiple times. We don’t even go into a room. We stop at the front desk. We pause. The ER doctor walks out to the stretcher. Many times, Dr. Felberg is still on the screen. Then we go directly to CT scan.

“The earlier we go to CT scan and identify if it’s a clot versus a bleed—each requires a different treatment—the faster the patient gets care,” she added.

When the paramedics meet a doctor in the CT scan room, the physician’s image is automatically switched from the monitor on the smaller InTouch Health Xpress to the monitor on the InTouch Health Lite, a person-sized robot that lives inside the ER.

“The inside robot came with Atlantic,” said Art Calise, medical director of Chilton emergency department. “It’s got great lenses. If the robot is at the end of the bed, it can see a patient’s pupil response. There’s even a stethoscope on the machine. If you put it on a patient’s chest, the doctor on the other end can hear the heartbeat.

“This has helped us tremendously with stroke,” he added. “In those cases in the past when the ER doctor thought, It’s a little iffy, the neurologists at Overlook can now look and say, ‘Definitely. Do it.’ So this is helping us deliver more tPA to more patients.” t-PA, or alteplase, is a clot-busting drug, Squillacote noted.

Different kinds of strokes

There are two kinds of stroke, a medical event in which blood flow to the brain is blocked and, consequently, brain nerve cells die.

Eighty-seven percent of strokes are ischemic, meaning they occur because of an obstruction in a blood vessel supplying blood to the brain, according to the American Stroke Association. The other kind is hemorrhagic, meaning a weakened blood vessel has ruptured, causing bleeding.

“The biggest piece of information we need in the emergency department is when the patient was last known to be well,” Squillacote said. “There’s a time window for giving t-PA —within four-and-a-half hours.

“Anything over that, the paramedics can still call one of the teleneurologists,” she added. “If we couldn’t give them the drug within that period of time, they can still do intervention at Overlook and we would transfer the patient there. You can go out to six hours to still treat them, maybe by going in and retrieving the clots.”

Chilton is a primary stroke center, Scalora said, but Overlook, whose stroke center is comprehensive, has more resources available and can treat more complex patients.

The technology, Dr. Felberg said, allows people who live anywhere in the area to get the best stroke care available.

“It used to be if you had a stroke and you lived in this area in New Jersey, you wouldn’t get the care or you had to travel into Manhattan,” he said. “Now we’re bringing the care to you. This is world-class, comprehensive stroke care brought to the local emergency room immediately, at the speed of the Internet.”

While the two InTouch units currently are used only for strokes, he added, telemedicine clearly presents many other possibilities for the future.

Lorraine Ash: 973-428-6660; lash@dailyrecord.com