Stroke is the 5th leading cause of death and adult disability in both the United States (US) and in the state of Tennessee. Effective, timely stroke assessment and diagnosis is essential to achieve positive patient outcomes, particularly during the time from Emergency Medical System (EMS) dispatch and transport to arrival at an Emergency Department (ED). This prehospital care is key to ensuring that eligible stroke patients receive tissue plasminogen activator (tPA) or interventional therapies. Unfortunately, tPA, the gold standard for stroke treatment, is often underutilized, as only ~5% of eligible stroke patients actually receive it. Utilization of tPA is also lower in rural areas, which have fewer Joint Commission-certified stroke centers compared to urban areas. EMS personnel are critical to improving timely assessment and diagnosis and providing accurate medical information to ED providers, including symptom start time, medical history, and demographic information. Paramedic stroke recognition and hospital pre-notification are significantly associated with shorter times from ambulance call to first medical assessment and door-to-computerized tomography (CT) scan performance, factors that double the rate of thrombolytic therapy given to patients. 
This presentation will describe a technology-enabled, rural telemedicine network and partnership for prehospital stroke assessment sponsored by a 2017 United States Department of Agriculture (USDA) Distance Learning and Telemedicine (DLT) grant. This feasibility study will utilize audio/video-enabled telemedicine technology mounted in ambulances to connect stroke-trained personnel from Vanderbilt University Medical Center and housed at Livingston Regional Hospital with EMS personnel in Jackson, Overton, and Pickett Counties in rural Tennessee.

ENABLING TELEMEDICINE LINKAGES FOR EMERGENCY MEDICAL SERVICES (EMS) AND STROKE-TRAINED PERSONNEL TO IMPROVE PREHOSPITAL STROKE ASSESSMENT AND DIAGNOSIS IN RURAL TENNESSEE