The utility of telestroke compared with paramedic scores to accurately identify stroke reperfusion candidates in the pre-hospital setting

The interventions consists of remote neurologist support for paramedics inside an ambulance to help diagnose whether a patient has truly suspected a stroke and whether they are eligible for reperfusion therapy. The support is rendered using iPads installed inside the ambulance connecting to the remote neurologist via videconferencing software. The workflow is outlined for the paramedics inside the ambulance using laminated cards. The videoconferencing approach allows the neurologist to make a verbal and visual assessment of the patient. This trial only assesses the diagnostic accurate of this approach, does not effect patient management, and does not involve any medications. Each individual patient will be assessed inside the ambulance only once during the ambulance transfer and each assessment will take between 5 and 15 minutes. The 'intervention' is an assessment itself that is standardised although we expect some degree of inter-assessor variation which is not dissimilar to any acute stroke assessment in light of the fact that patients vary between one another requiring some adaptation of the assessment approach. The control arm will be using standard pre-hospital paramedic assessment scores (FAST and PASTA) to confirm stroke diagnosis and likelihood of being a reperfusion therapy candidate. The scores consist of a few items around the patient's presentation (eg face weakness, speech difficulties, arm weakness) that are added up to determine diagnosis.