Digital Health–Enabled Prehospital Notification for Acute Stroke Using the Brain Saver Mobile App in Emergency Medical Transport in South Korea: Pilot Quasi-Experimental Study

BACKGROUND Timely access to stroke care is critical for patient prognosis. Despite the growing use of digital health 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 app, addresses this gap by facilitating real-time data sharing between EMS personnel and ED clinicians during stroke transport. OBJECTIVE This study aimed to examine the potential of the Brain Saver protocol to improve existing EMS-ED workflows in emergency stroke transport by describing its functional components, implementing a pilot intervention in a real-world setting, and exploring its preliminary impact on treatment timeliness. METHODS Data were collected in Pohang, South Korea, from December 2023 to April 2024 through collaboration with 2 fire stations, eight 119 EMS and safety centers, 3 hospitals, and SEERS Technology. Preintervention training and postintervention surveys were conducted among EMS personnel (n=80) and clinicians (n=24). In this pilot, patients with stroke (ICD-10 [International Classification of Diseases, Tenth Revision] codes I60-I63) in the intervention group (n=34) were transported using ambulances equipped with the Brain Saver mobile app, while the comparison group (n=129) was transported by standard ambulances to the same hospitals during the study period. With “needle” defined as any parenteral treatment, onset-to-door time and door-to-needle time were compared by group. After exact matching on age, baseline stroke severity, stroke type, and destination hospital, intervention effects were estimated using generalized estimating equations. RESULTS Participants (N=163) had a mean age of 69.4 (SD 15.2) years, 50.3% (82/163) were male, and 65.6% (107/163) had ischemic stroke. No significant baseline differences, including stroke severity, were observed between groups. The median onset-to-needle time was shorter in the intervention group than in the comparison group (114 vs 204 minutes; P=.03). In the matched analytic sample (n=91), the intervention group showed significant reductions in onset-to-needle time (Exp(β)=0.49; P=.009) and door-to-needle time (Exp(β)=0.67; P=.04) compared with the comparison group. CONCLUSIONS Integrating digital health into emergency stroke transport may improve care timeliness by supporting real-time prehospital notification and facilitating prompt in-hospital responses. The Brain Saver mobile app shows potential use for reducing onset-to-treatment time. Further larger-scale studies are needed to evaluate implementation fidelity and scalability.