Freeze the stroke: public awareness program for immediate detection of first symptoms

The capacity of the general population to identify stroke signs is a major determinant for success of prehospital emergency pathways. Previous educational strategies using the media were usually short-lived and expensive. Tailoring information programs for special subgroups like acute stroke relatives may improve this situation.

A poster was assembled that included a list of stroke signs and instructions to call 911. Consecutive admissions to the stroke unit were randomized. Intervention consisted of an educational session with relatives, in which a nurse delivered 5 posters and asked for their placement on the freezer door at the kitchen of the patient's house and each of 4 neighboring houses. One month later, a questionnaire was administered to both groups.

Sixty admissions were randomized (30 interventions), and 150 posters were distributed. One month after discharge, response rates were 81% for intervention group and 48% for control group. In the intervention arm, 64.5% had all the 4 answers correct, and 74.2% identified all first signs of stroke. For the control group, these values were 8% and 20%, respectively (P<0.001).

This stroke unit-based information strategy improved awareness of relatives and neighbors when compared with the usual discharge plan. The program avoids the media and explores regional health care structure and family and social organizations, and it targets a subgroup keen to receive and spread information. The low cost, ease of use, and duration of the stimulus facilitate further testing and evaluation of impact on hospital presentation and thrombolytic treatment rates.