Curriculum Innovation: Training the Front Line: A Neurologic Emergencies Curriculum Pilot for First Responders

Emergency medical services (EMS) clinicians play a critical role in early identification and management of neurologic emergencies yet may encounter sparse neurology-specific education. With interprofessional collaboration, we developed a multimodal, active-learning, and experiential curriculum for teaching prehospital care in a neurologically underserved setting. We evaluated curriculum feasibility and impact on prehospital neurologic assessment. The objectives of this study were to (1) recognize signs and symptoms of neurologic emergencies, aiding in the formulation of a prehospital differential diagnosis; (2) appraise patient encounter data for incorporation into prehospital medical decision making and facilitation of interprofessional communication and continuity of care; and (3) provide situation-specific prehospital care for patients with neurologic emergencies, including stabilization, medical management, triage, and disposition.

We delivered a 10-month longitudinal neurologic emergencies curriculum to EMS clinicians in Victoria, TX. The program included case-based learning, simulation, team gamification, and pilot web-based bedside teaching. Participants completed preknowledge and postknowledge assessments for in-person interactive sessions and a simulation, as well as a summative knowledge assessment. Learner reactions were assessed by changes in self-perceived familiarity with neurologic emergencies. We tracked local acute stroke care metrics (monthly median door-to-needle time (DTNT), incidence of thrombolysis, and incidence of thrombectomy transfer) before and after the curriculum to assess impact on recognition and triage skills.

EMS clinicians with varying experience levels participated in 221 session attendances. Short-term knowledge assessment scores improved for neurovascular (60 vs 80, p < 0.01), neuromuscular and spinal cord (60 vs 90, p < 0.01), and traumatic brain injury and headache (60 vs 90, p < 0.01) emergencies, but not for epilepsy/syncope/dizziness/encephalopathy (both 80, p = 0.12), nor summatively (both 80, p = 0.97). Postsimulation assessment showed significant knowledge gain (40 vs 80, p < 0.01). No postcurriculum difference in median DTNT (49 vs 45 minutes, p = 0.72) nor thrombolysis administration (both 2, p = 0.21) was observed; transfer for thrombectomy evaluation increased (1 vs 3, p = 0.02). Learners reported consistently moderate familiarity with neurologic emergencies but expressed appreciation for the case-based, differential diagnosis approach.

Short-term knowledge improved in several areas of our curriculum, most notably with simulation. Increase in thrombectomy transfers suggests potential impact on recognition and triage. Challenges included attendance amid clinical responsibilities and sample size. Long-term knowledge retention strategies, including ongoing simulation, may help sustain gains.