In USL Umbria 2 catchment area there are 4 hospitals for about 400k inhabitants. Only one of these, Foligno, has a fully equipped Emergency Department with a stroke pathway for thrombolysis.Among the other hospitals, the biggest one without a stroke center is Orvieto hospital (30k inhabitants, stroke hospitalization volume 100/year).
The catchment area of USL Umbria 2 covers both counties and the municipality of Foligno and Spoleto-Valnerina of the Perugia county as well as all the Terni County. Terni Stroke Unit is in the city Hospital included in the regional network but not fully interfacing with USL 2 provider. Blue arrows indicate the intranet connections; Yellow arrows indicate connection to the mobile unit.
Fig. 2b. Zoom to isocoria testing and fotomotor response.
Fig. 3b. Arrival of the vehicle to Cascia on 30th November 2016 with the Major Mr. Emili and Meytec staff with Mr. S. Meyer.
Fig. 3c. Set up at the hospital in Foligno.
- ECG devices
- Monitoring systems
- Point-of-care laboratory diagnostic systems
Portable ultrasound device
Stroke pathway development
In January 2017, the first i.v. thrombolysis was successfully performed in remote assistance, see below.
The patient suddenly presented, around 14 o'clock, weakness of the right upper limb and a speech disturbance. Once arrived in Orvieto Emergency Department a brain CT scan was performed, excluding bleedings or acute signs of infarction. The neurological teleconsultat was then activated and neurologic examination at about 15 pm highlighted: lower right facial palsy, right limbs hemiparesis (3/5 upper and 4/5 lower according to Medical Research Council score) speech was poor with anomie. The overall National Institute of Health Stroke Scale (NIHSS) score was 14. Blood pressure and heart rate were both normal.
- Corea F, Hubert G, Abilleira S. Letter by Corea et al Regarding Article, "Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke 2017 Jun;48(6):e139.
- F. Corea, A. Gamboni, P. Brustenghi, M. Bracaccia, P. Manzi and M. Zampolini a stroke network in internal areas of central Italy European Stroke Journal 2017, Vol. 2(IS) 98–476