In the case of a stroke, every second counts. The longer the patient waits for treatment – i.e., the longer the brain is starved for blood – the more permanent damage is done.For a patient in a remote area who might not have access to a stroke specialist, the options often are limited to an either/or situation: Either the patient can be transported to a larger facility where a stroke doctor is available, which would eat up precious time, or the patient can stay and receive care from someone whose training is not as specialized.Researchers at the University of California, San Diego Medical Center have added a new option to the list for patients who do not have access to stroke doctors. Thanks to a telemedicine program they call STRokE DOC (stroke team remote evaluation using a digital observation camera), local doctors and out-of-range specialists can videoconference over the Internet to determine the best course of treatment for stroke patients.Neurologist Brett C. Meyer, co-director of the hospital’s stroke center and associate clinical professor of neurosciences at UCSD School of Medicine, was the principal investigator for the STRokE DOC trial. UCSD collaborated with California Institute for Telecommunications and Information Technology of La Jolla, and with Qualcomm and BF Technologies Inc., both of San Diego. The study’s results were published online Aug. 3 in Lancet Neurology.Neurologist Brett C. Meyer, at the University of California, San Diego Medical Center, uses the STRokE DOC telemedicine program to examine a patient at El Centro Regional Medical Center in California. Meyer and his colleagues found two-way audio and video to be superior to telephone consultations. Courtesy of the University of California, San Diego Medical Center.“Depending on your definition of telemedicine, it’s been around in one form or another since about the twenties,” Meyer said.Meyer said that two-way audio/video systems have been researched since about the 1990s but that nothing on the scale of STRokE DOC had ever been produced.The secret is in the software, which enables two-way audio and video over a standard Internet connection. A remote-controlled mobile camera server, mounted on what is essentially an intravenous pole, is placed at the foot of the patient’s bed at the remote “spoke” site. This allows a stroke specialist at a “hub” site to observe and speak with the patient and attending medical professionals in real time. The patient’s records and test results, such as blood work and CT scan images, also are accessible through the program. The program is site-independent, meaning that hub specialists do not have to be sitting in their emergency rooms or offices.To test whether STRokE DOC is effective, Meyer and his team used decision making as their main criterion. “There was an assumption that the phone was effective,” he said, “so in our trials, one-half got consultations by phone and one-half got consultations by telemedicine.” A central group reviewed the decisions made by the clinicians and, based on the patients’ histories and test results, determined whether the decided-upon treatment was appropriate.“We found telemedicine made for better decision making,” Meyer said.It made for time saved, too. And when, as Meyer pointed out, a stroke patient loses 1.9 million neurons every minute, every second really does count. Considering that many hospitals have practitioners who do not live nearby, he added, millions and billions of neurons can be lost just waiting for the doctor to arrive at the hospital. But STRokE DOC could change that.“We tested how long it takes to start up the program, from the initial phone call,” Meyer said. “It was 20 seconds. And that included the time it took to download.”Lancet Neurology, September 2008, pp. 787-795.