JMIR Publications

ABSTRACT

Background:

Timely access to stroke care is critical for patient prognosis. Despite the growing use of digital health-based strategies in stroke management, evidence supporting seamless and timely care coordination from the emergency medical services (EMS) to the emergency department (ED) remains limited. Brain Saver, a newly developed mobile application, addresses this gap by enabling real-time communication between EMS personnel and ED clinicians and supporting coordinated emergency stroke transport.

Objective:

This study aimed to integrate the Brain Saver protocol into paramedic and ED clinician workflows during emergency stroke transport, describe its functional components, implement a pilot intervention in a real-world setting, and explore its preliminary impact on treatment timeliness and selected clinical outcomes.

Methods:

Data were collected in Pohang, South Korea, from December 2023 to April 2024 through collaboration with two fire stations, three hospitals, and SEERS Technology. Pre-intervention training and post-intervention surveys were conducted among EMS personnel (n=80) and clinicians (n=24). Through a pilot intervention, stroke patients (ICD-10 codes I60–I63) in the intervention group (n=34) were transported using ambulances equipped with the Brain Saver mobile application, while the comparison group (n=129) was transported by standard ambulances to the same hospitals during the study period. After exact matching on age, baseline stroke severity, and stroke type, intervention effects were estimated using generalized estimating equations.

Results:

Participants (n=163) had a mean age of 69.4 years (SD 15.2), 50.3% were male, and 65.6% had ischemic stroke, with no significant differences between groups. In the intervention group (n=34), 69.0% arrived at the hospital within 3 hours of symptom onset, 60.0% were treated within 60 minutes of arrival, and 76.9% achieved an onset-to-needle time within 4.5 hours. The median onset-to-needle time was shorter in the intervention group than in the comparison group (114 vs. 204 minutes; P = .030). This intervention effect remained after adjustment, corresponding to a 34% reduction in onset-to-needle time (Exp(β) = 0.66; P = .008) and a 24% reduction in door-to-needle time (Exp(β) = 0.76; P = .067) compared with the comparison group. Improvements in clinical outcomes were modest and not statistically significant, including a shorter length of hospital stay (Exp(β) = 0.52; P = .061) and lower odds of severe post-stroke disability (OR = 0.84; 95% CI 0.55–1.28).

Conclusions:

Integrating digital health into emergency stroke transport may improve care timeliness by supporting real-time prehospital notification and coordination across EMS and ED workflows. The Brain Saver mobile application appears feasible and shows potential utility for improving treatment timeliness by facilitating prompt in-hospital responses. Further larger-scale studies are needed to evaluate implementation fidelity, scalability, and clinical effectiveness.