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Original research
Using G-FAST to recognize emergent large vessel occlusion: a training program for a prehospital bypass strategy
  1. Yu-Chen Chiu1,
  2. Sung-Chun Tang2,
  3. Jen-Tang Sun1,
  4. Li-Kai Tsai2,
  5. Ming-Ju Hsieh3,
  6. Chung-Wei Lee4,
  7. Jiann-Shing Jeng2,
  8. Yu-Ching Lee5,
  9. Yu-Chun Chien6,
  10. Yao-Cheng Wang6,
  11. Wen-Chu Chiang7,
  12. Matthew Huei-Ming Ma7
  1. 1 Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
  2. 2 Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
  3. 3 Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
  4. 4 Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
  5. 5 Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan
  6. 6 Fire Department of the City of Taipei, Taipei, Taiwan
  7. 7 Department of Emergency Medicine, National Taiwan University Hospital YunlinBranch, Yunlin County, Taiwan
  1. Correspondence to Dr. Ming-Ju Hsieh, Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan ; erdrmjhsieh{at}


Introduction The 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.

Methods All 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.

Results In 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.

Conclusions A 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.

  • emergent large vessel occlusion
  • endovascular thrombectomy
  • emergency medical service
  • G-FAST
  • training
  • experience

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  • Contributors All authors made substantial contributions to the design of the analysis, interpretation of data, drafting, critically revising and final approval for the manuscript.

  • Funding The article was supported by National Taiwan University Hospital (108-09) and the Taiwan Ministry of Science and Technology (MOST 106-2314-B-002 -091 and MOST 105-2314-B-002 -026).

  • Competing interests None declared.

  • Ethics approval Institutional review board of the National Taiwan University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.