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

Abstract

IntroductionThe shorter the time between the onset of symptoms and reperfusion using endovascular thrombectomy, the better the functional outcome of patients. A training program was designed for emergency medical technicians (EMTs) to learn the gaze-face-arm-speech-time test (G-FAST) score for initiating a prehospital bypass strategy in an urban city. This study aimed to evaluate the effect of the training program on EMTs.MethodsAll EMTs in the city were invited to join the training program. The program consisted of a 30 min lecture and a 20 min video which demonstrated the G-FAST evaluation. The participants underwent tests before and after the program. The tests included (1) a questionnaire of knowledge, attitudes, confidence, and behaviors towards stroke care; and (2) watching 10 different scenarios in a video and answering questions, including eight sub-questions of G-FAST parameters, and choosing a suitable receiving hospital.ResultsIn total, 1058 EMTs completed the training program. After the program, significant improvement was noted in knowledge, attitudes, and confidence, as well as scenario judgement. The performance of the EMTs in evaluating G-FAST criteria in comatose patients was relatively poor in the pre-test and improved significantly after the training course. Although the participants answered the G-FAST items correctly, they tended to overtriage the patients and refer them to higher-level hospitals.ConclusionsA short training program can improve the ability to identify stroke patients and choose a suitable receiving hospital. A future training program could put further emphasis on how to evaluate comatose patients and choose a suitable receiving hospital.

Pre-hospital stroke screening and notification of patients with reperfusion-eligible acute ischaemic stroke using modified Face Arm Speech Time test

“…Our experience is consistent with the reports from other medical systems that have implemented stroke alert systems to reduce door-to-needle time. [10][11][12] Notably, the present study demonstrated that the door-to-groin puncture time for thrombectomy candidates was also markedly reduced by pre-arrival notification, enabling the majority of patients to undergo groin puncture within 120 minutes. This is likely due to the longer time required to coordinate the neurointerventionist, interventional suite, and anaesthesiology care team; this process was initiated early with pre-arrival stroke notification.…”

“…3 Future efforts should focus on pre-hospital screening of thrombectomyeligible patients with large vessel occlusion and establishment of a diversion system to ensure patients are transported to thrombectomy-capable hospitals. 10 One concern related to pre-hospital stroke screening was the potential for over-calling and thus overloading the acute stroke treatment pathway, thereby negatively affecting the AED service for patients with non-stroke emergencies. To maximise cost-effectiveness, the screening criteria were tailored to reduce notification for patients with stroke mimics and to exclude patients who were unlikely to benefit from acute reperfusion therapy.…”