Background and Aims
In-ambulance telemedicine is a promising and scalable approach bringing medical experts virtually to the patients’ location. 
Method
The AP19-IATS project has a prospective, multi-center observational design. It aims to implement 24/7 in-ambulance telestroke care in 2 academic hospitals, supported by a group of 6 independent teleconsultants (all senior neurovascular experts) operating from different sites in and outside Belgium. All patients >18 yo, with suspicion of acute stroke and symptom onset <12 hours are eligible for inclusion.
Results
During the trial phase from November 7th until December 22th 2017, 24/7 support via in-ambulance telemedicine was provided by six teleconsultants, resulting in zero missed teleconsultation attempts. Five out of six teleconsultants were not part of the in-hospital stroke team of the participating hospitals. Of 20 attempts, teleconsultation was performed in 14 cases. Unsuccessful attempts were mainly due to technical issues (software update n=1, teleconsultation device maintenance n=1, connectivity problems n=2), in 2 cases additional value of teleconsultation was judged to be lacking by the attending on-site emergency physician (no suspicion of stroke, n=2). No telemedicine-related adverse events occurred.
Conclusion
This is the first report on 24/7 in-ambulance telestroke in a network of multiple hospitals, supported by a group of six independent teleconsultants. This project has uniquely and successfully demonstrated off-site in-ambulance teleconsultation across hospital and country borders to be feasible and safe, without major organizational issues. Large scale studies are needed to assess long term feasibility and clinical effects of in-ambulance telestroke interventions.

OFF-SITE MULTICENTER IN-AMBULANCE TELESTROKE: A FEASIBILITY STUDY IN TWO BELGIAN ACADEMIC HOSPITALS