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

Abstract

Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019, and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8–57.6) vs 28.1% (95% CI 20.1–27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5–90.5) vs 69.8% (60.0–78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8–77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0–68.0), brain tumours (56.3%, 95% CI 48.5–63.8), and seizures (54.4%, 95% CI 46.7–62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4–11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusion: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving an insufficient amount of feedback on suspected stroke patients, even though the usefulness is perceived to be paramount.

Gambaran Tingkat Pengetahuan Paramedis tentang Pencegahan Primer Stroke di Rumah Sakit Umum Cut Meutia Aceh Utara

“…Dengan pengetahuan yang memadai, paramedis dapat dengan cepat mengenali gejala stroke, memulai manajemen dini yang tepat, dan segera mengarahkan pasien ke fasilitas kesehatan yang sesuai (27). Pelatihan yang terus-menerus akan meningkatkan pengetahuan paramedis sehingga paramedis selalu mendapatkan pemahaman terkini tentang penanganan stroke berdasarkan penelitian dan praktik terbaru (28). Hal ini juga dapat dipengaruhi oleh pengalaman paramedis dalam menangani pasien selama bekerja.…”

“…Pengetahuan paramedis tentang faktor risiko stroke mayoritas responden memiliki pengetahuan yang cukup yaitu 75,8% (69 responden). Artinya paramedis cukup mengetahui tentang faktor risiko stroke namun belum mencapai kriteria baik sehingga pengetahuan mereka tentang faktor risiko stroke harus ditingkatkan dengan cara memberikan eduksai, pelatihan, atau seminar yang berkaitan dengan stroke agar mereka dapat mengedukasi dan melakukan pencegahan stroke pada masyarakat sehingga angka kejadian stroke di masyarakat dapat menurun (28,30). Pengetahuan paramedis tentang faktor risiko stroke sangat penting karena mereka memiliki peran kunci dalam memberikan edukasi, pencegahan, dan pengelolaan pasien yang berisiko mengalami stroke.…”