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Ischemic Stroke
Original research
Emergency medical systems education may improve knowledge of pre-hospital stroke triage protocols
  1. Eleanor L DiBiasio1,
  2. Mahesh V Jayaraman2,3,4,5,
  3. Lori Oliver2,5,
  4. Gino Paolucci2,5,
  5. Michael Clark2,5,
  6. Cristina Watkins2,5,
  7. Karen DeLisi3,5,
  8. Ann Wilks5,
  9. Shadi Yaghi3,5,
  10. Morgan Hemendinger3,
  11. Grayson L Baird2,6,
  12. J Adam Oostema7,
  13. Ryan A McTaggart2,3,4,5
  1. 1 Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
  2. 2 Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
  3. 3 Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
  4. 4 Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
  5. 5 Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island, USA
  6. 6 Lifespan Biostatistics Core, Rhode Island Hospital, Providence, Rhode Island, USA
  7. 7 Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
  1. Correspondence to Dr. Ryan A McTaggart, Departments of Diagnostic Imaging, Neurology, and Neurosurgery Warren Alpert School of Medicine at Brown University Rhode Island Hospital 593 Eddy Street, Room 377 Providence, RI 02903 USA ; ryan.mctaggart{at}lifespan.org

Abstract

Background Following the results of randomized clinical trials supporting the use of mechanical thrombectomy (MT) with tissue plasminogen activator for emergent large vessel occlusion (ELVO), our state Stroke Task Force convened to: update legislation to recognize differences between Primary Stroke Centers (PSCs) and Comprehensive Stroke Centers (CSCs); and update Emergency Medical Services (EMS) protocols to triage direct transport of suspected ELVO patients to CSCs.

Purpose We developed a single-session training curriculum for EMS personnel focused on the Los Angeles Motor Scale (LAMS) score, its use to correctly triage patients as CSC-appropriate in the field, and our state-wide EMS stroke protocol. We assessed the effect of our training on EMS knowledge.

Methods We assembled a focus group to develop a training curriculum and assessment questions that would mimic real-life conditions under which EMS personnel operate. Ten questions were formulated to assess content knowledge before and after training, and scores were compared using generalized mixed models.

Results Training was provided for 179 EMS providers throughout the state.

Average pre-test score was 52.4% (95% CI 49% to 56%). Average post-test score was 85.6% (83%–88%, P<0.0001). Each of the 10 questions was individually assessed and all showed significant gains in EMS knowledge after training (P<0.0001).

Conclusions A brief educational intervention results in substantial improvements in EMS knowledge of prehospital stroke severity scales and severity-based field triage protocols. Further study is needed to establish whether these gains in knowledge result in improved real-world performance.

  • stroke

https://doi.org/10.1136/neurintsurg-2018-014108

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    Footnotes

    • Twitter @mobilestroke4U

    • Contributors ELD helped in conceptualization of the research project, design of the assessment tool, data collection, statistical analysis, and drafted and revised the paper. MVJ was involved in data collection and drafting and revising the paper. LO, CW, MC, GP, and KD contributed to design of the assessment tool, implementation of training sessions, data collection, and drafting and revision of the paper. AW was involved in implementation of training sessions and data collection. SY was involved in drafting and revision of the paper. MH contributed data collection, statistical analysis, and drafting and revision of paper. GLB helped in conceptualization of the research project, design of the assessment tool, led the statistical analysis, and helped draft and revise the paper. JAO was integral to interpretation of the data and critical revision of the work. RAM was involved in conceptualization of the research project, design of the assessment tool, implementation of training sessions, and drafting and revising the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Lifespan - Rhode Island Hospital IRB.

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