Introduction: Emergency Medical Services (EMS) are an important component of stroke systems of care. EMS transport has been associated with faster emergency department (ED) stroke evaluations and higher t-PA delivery rates, especially among EMS recognized cases with hospital prenotification. However, delivery of high quality care including hospital prenotification requires that paramedics received regular education and training to improve their ability to identify and treat stroke cases.
Methods: We identified opportunities for improvement in EMS care of suspect stroke patients through a review of local EMS stroke-related performance data and focus group discussions with paramedics. We then developed a 20-minute online educational module that reviewed basic stroke pathophysiology, discussed acute stroke therapies, and stressed the importance of performing stroke screening examinations and hospital prenotification for suspect stroke cases. The training was provided to all paramedics in a single agency. Scores on 10 item multiple-choice assessment were compared before and after receipt of the online training module using Fisher Exact tests and Wilcoxon Rank Sum Tests.
Results: A total of 40 paramedics underwent the training. Overall quiz scores improved from a median of 9 (interquartile range [IQR] 7 to 9) to 10 (IQR 9 to 10, p=0.0002). Prior to training, only 43% of paramedics correctly identified 4.5 hours as the window for t-PA treatment, with 43% choosing 6 hours. Correct t-PA window identification improved significantly following education (43% to 87.5%, p<0.0001). Improvements were also seen for questions regarding the most common presenting complaints among EMS missed strokes (72.5% to 90%) and the recommended time frame for verbal hospital prenotification (80% to 95%), although these differences were not statistically significant.
Conclusions: Overall, paramedics demonstrated good baseline knowledge regarding stroke, however important misconceptions regarding the time frame for t-PA eligibility were common. A brief, on-line educational intervention improved stroke knowledge. Further work is needed to determine the impact of stroke education on real world paramedic performance.