Background: EMS stroke recognition and hospital prenotification facilitate rapid stroke treatment. However, EMS stroke recognition is suboptimal. To promote stroke recognition, we deployed a 30-minute online EMS educational module in a single southwestern Michigan county.
Methods: Following 12 months of baseline data collection, the online module was completed by all paramedics in the study county. An interrupted time series design was used to measure the impact of the educational intervention in the subsequent 9 months. Prehospital and hospital data were collected for all EMS suspected stroke cases and hospital confirmed strokes that were missed by EMS. We compared the sensitivity and overcall (false positive) rate of an EMS stroke impression during the pre- and post-intervention periods. We also compared stroke scale documentation, prehospital notification, and door-to-CT (DTCT) times.
Results: Over a 21-month period, 1656 cases were included: 744 EMS identified strokes, 408 EMS missed strokes, and 504 EMS overcalled cases (not strokes). Following the intervention, EMS sensitivity for stroke recognition increased from 65.3% to 71.5% (p=0.048) without change in the proportion of overcalls (39.4% to 40.8%, p=0.65). However, improvement in sensitivity was limited to the first post-intervention quarter (65.3% to 74.0%, p=0.027), and returned to baseline thereafter (figure). Among 1109 confirmed stroke cases, EMS hospital prenotification improved following the intervention (57.1% to 81.6%, p<0.0001) but there was no change in stroke scale documentation (67.4 % vs. 67.8%, p=0.93). A higher likelihood of a DTCT time ≤25 minutes was observed only in the first post-intervention quarter (55.4% vs. 43.5%, p=0.0045).
Conclusions: A brief, web-based educational intervention was associated with higher EMS stroke recognition without an increased rate of stroke overcalls. Although improvements were transient, they coincided with improved DTCT times.