Two hospitals in The T&D Region are being eyed for inclusion in the first phase of a telemedicine system designed to improve emergency response to individuals in rural communities with acute stroke symptoms.

Stroke is the third leading cause of death in South Carolina, and telemedicine is being touted as a valuable tool in emergency stroke consultation between stroke specialists and remote emergency department physicians.

Telemedicine is broadly defined as the diagnosis and treatment of patients in remote areas using medical information, as x-rays or television pictures, transmitted over long distances, especially by satellite. Electronic, visual and audio communications are all used to provide diagnostic and consultation support to practitioners at distant sites, assist in or directly deliver medical care to patients at distant sites, and enhance the skills and knowledge of distant medical care providers.

Dr. Robert J. Adams is the endowed chair for Health Sciences of South Carolina's Stroke Center. The vascular neurologist is leading a unique effort that is using telemedicine to link small, rural hospitals with experts in stroke care at the Medical University of South Carolina. The program is called Remote Evaluation of Acute Ischemic Stroke, or REACH.

Start-up funds for the pilot project were provided by Health Sciences of South Carolina, which was founded in April 2004 with a vision of improving the health and economic well-being of the state through a coordinated strategy to advance research and education.

Adams and fellow vascular neurologist Dr. Ken Gaines serve as co-chairmen of a committee that the American Stroke Association set up to investigate the delivery of stroke care in South Carolina.

"We've been looking at just the issue of trying to develop appropriate methods of care and putting in a telemedicine system. What we would probably do is develop a three-unit tertiary care base," Gaines said, including the MUSC in Charleston, Palmetto Health/University of South Carolina School of Medicine in Columbia and the Greenville Hospital System in Greenville.

"They would be the key receiving tertiary care institutions for the more advanced stroke care, and then other places could be either staffed by local neurologists -- if they had the capacity and interest -- or through the telemedicine system," he said.

The REACH program is currently based at MUSC, but Gaines said there are local sites involved in first-phase development.

"We have already met with and established plans to develop this at Bamberg (County Memorial Hospital). Their emergency room staff, as well as hospital administration, was very supportive of this. We would anticipate that they would be in the first group of institutions that we involved in this," he said. "I will be meeting with the group in Orangeburg at the Regional Medical Center (on) June 2 to have a discussion with their emergency room physician and hospital administration about becoming involved in this."

Gaines and Adams are two of only three board-certified vascular neurologists in the state. Gaines said they will form a team with the state's several trained vascular neurologists to provide care within the telemedicine system.

"This group will form stroke teams, providing telemedicine consults and then taking care of patients if they're actually transported to a tertiary facility," Gaines said. "There's a lot to be gained with a system like this. The patient is really the key, and the attempts are to provide a high-resolution diagnosis, get the best minds to decide what treatment options are and to institute those as quickly as possible."

"Telemedicine really helps to improve all three of those pieces of care," he said. "I've been doing this for 30 years, and there's a big change in how things have evolved from no urgency at all to really extreme, similar to a heart attack and trauma. We're in a very high-risk area for stroke, and there's a time-window of opportunity that closes fairly quickly once patients have stroke. Systems of care to address that really need development ... ."

The system will also help address health disparities in the state, particularly since blacks experience a greater incidence of stroke. The American Heart Association reports that black Americans are twice as likely to have a stroke as any other group.

Adams said the system will allow rural hospitals to partner with MUSC and get immediate access to stroke specialists who, with the help of the Internet, assist in rapid diagnosis and stroke treatment.

"Working with hospitals, we hope to return more patients to pre-stroke health," he said. "Stroke is 90 percent preventable. Reducing risk factors and improving education, prevention and treatment-appropriate rehabilitation -- we've got to do all of these things to stop stroke."

T&D Staff Writer Dionne Gleaton can be reached by e-mail at dgleaton@timesanddemocrat.com or by telephone at 803-533-5534. Discuss this and other stories online at TheTandD.com.

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