Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time

Abstract

Background and PurposeAcute stroke treatment outcomes are predicated on reperfusion timeliness which can be improved by better prehospital stroke identification. We aimed to assess the effect of interactive emergency medical services (EMS) training on stroke recognition and prehospital care performance in a very high-risk cardiovascular risk population in Lithuania.MethodsWe conducted a single-center interrupted time-series study between March 1, 2019 and March 15, 2020. Two-hour small-group interactive stroke training sessions were organized for 166 paramedics serving our stroke network. We evaluated positive predictive value (PPV) and sensitivity for stroke including transient ischemic attack identification, onset-to-door time, and hospital-based outcomes during 6-months prior and 3.5 months after the training. The study outcomes were compared between EMS providers in urban and suburban areas.ResultsIn total, 677 suspected stroke cases and 239 stroke chameleons (median age 75 years, 54.8% women) were transported by EMS. After the training, we observed improved PPV for stroke recognition (79.8% vs. 71.8%, p = 0.017) and a trend of decreased in-hospital mortality (7.8% vs. 12.3, p = 0.070). Multivariable logistic regression models adjusted for age, gender, EMS location, and stroke subtype showed an association between EMS stroke training and improved odds of stroke identification (adjusted odds ratio [aOR] 1.6 [1.1–2.3]) and onset-to-door ≤ 90 min (aOR 1.6 [1.1–2.5]). The improvement of PPV was observed in urban EMS (84.9% vs. 71.2%, p = 0.003), but not in the suburban group (75.0% vs. 72.6%, p = 0.621).ConclusionsThe interactive EMS training was associated with a robust improvement of stroke recognition, onset to hospital transport time, and a trend of decreased in-hospital mortality. Adapted training strategies may be needed for EMS providers in suburban areas. Future studies should evaluate the long-term effects of the EMS training and identify optimal retraining intervals.

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

“…We conducted a cross-sectional survey of Vilnius city and district paramedics between September and November 2019. A structured paper questionnaire was distributed to all the EMS staff who participated in stroke care training at Vilnius University Hospital [ 11 ] before the start of the training. To elucidate the factors associated with paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke outcomes, we reviewed the current literature on paramedic surveys concerning stroke care.…”

“…Essential emergency health services in Lithuania are free of charge and EMS are the first responders in the majority of medical emergencies. Each EMS unit in Lithuania is staffed by a two-person team—a specialist-paramedic, and a driver-paramedic [ 11 ]. In urban areas, each EMS unit can serve up to a maximum of 18,000 inhabitants, and up to 16,000 inhabitants in suburban areas.…”

“…Regularly updated national Lithuanian stroke care guidelines encompass the prehospital stroke care setting [ 16 ]. Although following the National law, all EMS agencies across the country utilize identical dispatch protocols [ 17 ], and due to sheer geographic differences, the median onset-to-door time is significantly longer for stroke patients carried by suburban EMS agencies of our stroke care network, by around 44 min [ 11 ].…”

“…One way to improve the quality of prehospital stroke care is through continuing professional development [ 10 , 11 ]. In addition, regular feedback to paramedics on their transported patients could also be an important tool that would enable learning from everyday practical experience [ 12 , 13 ].…”

Reperfusion Therapies for Acute Ischemic Stroke in COVID-19 Patients: A Nationwide Multi-Center Study

“…The first COVID-19 case in Lithuania was confirmed in late February 2020, followed shortly by the introduction of a strict nationwide lockdown. Despite thousands of daily new confirmed cases and the need for allocation of specific healthcare resources, emergency stroke services were operating in all major stroke centers across the country throughout the pandemic at full capacity [ 10 , 11 ]. Both intravenous thrombolysis (IVT) and endovascular treatment (EVT) were used continuously for acute ischemic stroke (AIS) in COVID-19 patients.…”