The “Flying Intervention Team”: A Novel Stroke Care Concept for Rural Areas

This paper presents an overview of several strategies to extend the geographical coverage of stroke treatment services, for example “The Mothership” and “Drip-and-ship”. This paper also presents a new model which uses a “flying intervention team”. This model showed very encoraing results on a pilot in Bavaria, Germany. It might a suitable model to implement in countries with enough resources.

The “Flying Intervention Team”: A Novel Stroke Care Concept for Rural Areas

Background: Endovascular treatment of large vessel occlusion in acute ischemic stroke patients is difficult to establish in remote areas, and time dependency of treatment effect increases the urge to develop health care concepts for this population.

Summary: Current strategies include direct transportation of patients to a comprehensive stroke center (CSC) (“mothership model”) or transportation to the nearest primary stroke center (PSC) and secondary transfer to the CSC (“drip-and-ship model”). Both have disadvantages. We propose the model “flying intervention team.” Patients will be transported to the nearest PSC; if telemedically identified as eligible for thrombectomy, an intervention team will be acutely transported via helicopter to the PSC and endovascular treatment will be performed on site. Patients stay at the PSC for further stroke unit care. This model was implemented at a telestroke network in Germany. Fifteen remote hospitals participated in the project, covering 14,000 km2 and a population of 2 million. All have well established telemedically supported stroke units, an angiography suite, and a helicopter pad. Processes were defined individually for each hospital and training sessions were implemented for all stroke teams. An exclusive project helicopter was installed to be available from 8 a.m. to 10 p.m. during 26 weeks per year.

Key Messages: The model of the flying intervention team is likely to reduce time delays since processes will be performed in parallel, rather than consecutively, and since it is quicker to move a medical team rather than a patient. This project is currently under evaluation (clinicaltrials NCT04270513).

Read the full paper here:

Gordian Jan Huberta, Frank Krausa, Christian Maegerleinb, Sabine Platenc, Benjamin Friedrichb, Hans-Ulrich Kaind, Thomas Witton-Daviese, Nikolai Dominik Huberta, Claus Zimmerb, Philip M. Bathf, Heinrich J. Audebertg, h Roman L. Haberla

Ensuring patients have equal access to care irrelevant of their geographical location is an ongoing consideration in our work at Nicolab. With StrokeViewer we hope physicians in more rural primary centres are able to communicate and collaborate more efficiently with experts at the intervention centre. With seamless image exchange and centralised patient information we hope primary and intervention centres can coordinate patient care swiftly to provide patients with the right treatment in time.

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