A nationwide prehospital stroke survey

Area of Science:

• Emergency Medicine
• Neurology
• Prehospital Care

Background:

• Stroke is a leading cause of long-term disability.
• Effective prehospital stroke management is critical for patient outcomes.
• Knowledge gaps among prehospital providers can impede timely and appropriate care.

Purpose of the Study:

• To assess the existing knowledge of stroke signs, symptoms, risk factors, and management among prehospital providers.
• To identify specific areas of deficiency in stroke knowledge for paramedics (EMT-Ps) and advanced EMTs (EMT-Is).
• To inform targeted educational interventions for prehospital stroke care.

Main Methods:

• A nationwide survey using multiple-choice questions was administered to a random sample of EMT-Ps and EMT-Is.
• The survey included questions on demographics, training, general stroke knowledge, and management strategies.
• Statistical analysis (chi-square or Fisher's exact test) compared knowledge levels between EMT-Ps and EMT-Is.

Main Results:

• While most providers recognized stroke as a brain injury, significant deficiencies were noted in defining transient ischemic attacks (TIAs) and understanding the 3-hour window for tissue plasminogen activator (tPA) administration.
• Fewer EMT-Is than EMT-Ps correctly defined TIAs and understood the tPA time window.
• A majority of both groups incorrectly believed elevated blood pressure should be lowered in the prehospital setting for stroke patients.

Conclusions:

• Prehospital providers possess general knowledge of stroke symptoms but require enhanced education on critical aspects like the thrombolytic therapeutic window and appropriate blood pressure management.
• Specific educational focus is needed regarding transient ischemic attacks (TIAs).
• Addressing these knowledge gaps is essential for optimizing prehospital stroke response and improving patient outcomes.