An Interventional Study to Improve Paramedic Diagnosis of Stroke

Abstract

Targeted stroke education and the use of a simple clinical tool can significantly improve the diagnostic sensitivity of stroke by paramedics in the prehospital setting. Accurate diagnosis combined with pre-notification of the pending arrival of stroke patients will allow for the focused and timely application of resources for the management of acute stroke.

Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient

“…The most common and well-investigated tools are the Cincinnati Prehospital Stroke Scale and the Los Angeles Prehospital Stroke Screen. 22,30,32,60 Newer stroke identification tools include the Face Arm Speech Test 61 (Table 3), which is similar to the Cincinnati Prehospital Stroke Scale, and the Melbourne Prehospital Stroke Scale, [62][63][64] which is similar to the Los Angeles Prehospital Stroke Screen. Tools to rate stroke severity in the field have been developed, including a shortened version of the NIH Stroke Scale (NIHSS) 65 and the Los Angeles Motor Scale.…”

EMS Management of Acute Stroke—Prehospital Triage (Resource Document to NAEMSP Position Statement)

“…Two common prehospital stroke instruments, the Los Angeles Prehospital Stroke Screen (LAPSS) and the Cincinnati Prehospital Stroke Scale (CPSS), have both demonstrated sensitivities of greater than 90% 29,32,33 In addition, the more recent Melbourne Ambulance Stroke Screen (MASS), which is an amalgamation of the CPSS and LAPSS, has also shown a sensitivity of 90%. 33,34 Some studies have shown that EMS dispatchers may be trained to a modified stroke identification instrument, which can be effective in optimizing stroke care.…”

Assessment of Stroke Patients’ Status and Their Transfer Time by Emergency Medical Services to Valiasr Hospital in Arak City, Iran

“…A stroke is an interruption of cerebral circulation, occurs when a clot blocks the blood supply to the brain or a blood vessel in the brain bursts [13,14]. Stroke symptoms may begin with central nervous system function failure [15].…”

“…In other words, EMS links hospitals and other medical centers to community, attempts to provide required emergency information and services in a suitable method and in a short time, and take the patients to the nearest medical center to prevent serious complications that can threat their lives [26]. Paramedics are the first medical contact in 38% to 70% of stroke patients and maximum delay in the assessment and treatment of stroke occurs in pre-hospital phase [13,27,28]. Thus, emergency medical technicians play an important role in the management of patients in acute phase as well as an essential part in stroke treatment team [29,30].…”

“…They can reduce the response time of the pre-hospital care of these patients [17]. Common standard protocols for stroke diagnosis in the world are FAST (Face, Arm, Speech ,Test), CPSS (Cincinnati Prehospital Stroke Scale), and LAPSS (Los Angeles Prehospital Stroke Screen) [13,23,32]. Chenkin et al following the implementation of a diagnostic protocol in a city, witnessed the increased number of stroke patients' eligible to receive tissue Plasminogen Activator (tPA) to 17.2% [33].…”