Using G-FAST to recognize emergent large vessel occlusion: a training program for a prehospital bypass strategy

Area of Science:

• Neurology
• Emergency Medicine
• Medical Education

Background:

• Rapid reperfusion via endovascular thrombectomy improves patient outcomes after stroke.
• Prehospital stroke assessment and bypass strategies are crucial for timely treatment.
• The gaze-face-arm-speech-time (G-FAST) score aids in prehospital stroke evaluation.

Purpose of the Study:

• To evaluate the effectiveness of a training program for emergency medical technicians (EMTs) on stroke identification using the G-FAST score.
• To assess the impact of training on EMTs' knowledge, attitudes, confidence, and behaviors in stroke care.
• To determine if the training improved EMTs' ability to select appropriate receiving hospitals for stroke patients.

Main Methods:

• A training program involving a lecture and video demonstration of the G-FAST evaluation was delivered to EMTs.
• Participants completed pre- and post-training assessments, including knowledge questionnaires and scenario-based evaluations.
• The assessments measured knowledge, attitudes, confidence, behavior, G-FAST parameter accuracy, and hospital selection.

Main Results:

• 1058 EMTs completed the training, showing significant improvements in knowledge, attitudes, and confidence regarding stroke care.
• Post-training performance in evaluating G-FAST criteria, especially in comatose patients, improved significantly.
• While G-FAST item accuracy increased, EMTs demonstrated a tendency towards overtriage, referring patients to higher-level hospitals.

Conclusions:

• A concise training program effectively enhances EMTs' stroke patient identification and hospital selection capabilities.
• Future training should focus more on evaluating comatose stroke patients and optimizing hospital referral decisions.
• Improved prehospital stroke assessment through targeted training can lead to better patient outcomes.