A nationwide prehospital stroke survey

Abstract

Objectives. To identify deficiencies in stroke knowledge among prehospital providers. Methods. A nationwide multiple-choice survey was sent to 689 paramedics (EMT-Ps) and 294 advanced EMTs (EMT-Is) from a random selection of the National Registry of Emergency Medical Technicians database. Of the 23 questions, five addressed demographic information, four quantity of training, five general knowledge, and seven management, and two open-ended questions addressed the signs, symptoms, and risk factors of stroke. The EMT-P and EMT-I answers were compared using chi-square analysis or Fisher's exact test. Results. Of the 355 (36%) respondents, 256 (72%) were EMT-Ps and 99 (28%) were EMT-Is. Virtually all the EMT-Ps (99%) and EMT-Is (98%) knew that a stroke injures the brain, but only 199 (78%) of the EMT-Ps and 47 (47%) of the EMT-Is correctly defined a transient ischemic attack (TIA) (p < 0.001). Slurred speech, weakness/paralysis, and altered mental status were the three most commonly cited symptoms of stroke by both groups. The EMT-Ps were more likely to recognize that dextrose is potentially harmful to stroke patients [EMT-P = 216 (85%), EMT-I = 71 (72%), p = 0.0051; 169 (66%) of the EMT-Ps and 75 (76%) of the EMT-Is felt that elevated blood pressures should be lowered in the prehospital setting. Only 93 (36%) of the EMT-Ps and 22 (22%) of the EMT-Is knew that tissue plasminogen activator (PA) must be given within three hours of symptom onset (p = 0.01). Conclusion. Most EMS providers are knowledgeable about the symptoms of stroke but are unaware of the therapeutic window for thrombolysis and the recommended avoidance of prehospital blood pressure reduction. In addition, further education is needed regarding TIAs.

Key Words:

• stroke
• emergency medical services
• thrombolytics
• transient ischemic attack.