Abstract
Background: Stroke education of emergency medical service (EMS) personnel improves stroke recognition, prenotification, and thrombolytic delivery. Prehospital identification of large vessel occlusion (LVO) stroke may facilitate the creation of a regional bypass protocol and improvement of intrahospital and interhospital workflows. However, the current status of EMS personnel's knowledge of LVO, their stroke severity assessment training, and preferences in educational methods have not been studied. We conducted an EMS survey across the United States.
Methods: The Society of Vascular and Interventional Neurology (SVIN) in collaboration with EMS-World created an online questionnaire distributed to all subscribers of EMS-World involved in pre-hospital work. It included 12 multiple-choice questions to test participants on LVO knowledge, stroke center certification levels, prior LVO education, and preferences on educational content delivery.
Results: The survey email was opened by 1830 subscribers out of whom 1107 (60%) completed the survey across 50 states in the United States. Respondents identified themselves as paramedics/EMTs (91.4%), ground critical care (5.7%) and flight crew (2.9%). The number of stroke patients that survey participants transported in the past year was <10 for 618 (55.8%), 10 to 25 for 332 (30%), and >25 (14.2%). Two hundred eighty-five (25.8%) participants answered both LVO knowledge questions correctly and 379 (34.2%) answered one correctly. Only 128 (11.6%) correctly identified all types of centers with thrombectomy capability. Although 877 (79.2%) were familiar with at least one stroke severity scale, 376 (34%) denied receiving training to perform them. Five sixty-seven (51.2%) respondents preferred in-person training for LVO training and 429 (38.8%) an online training program. About half of all respondents (535,48%) picked 'lack of standardized LVO training' as the greatest hurdle to pre-hospital LVO management.
Conclusion: EMS providers in the United States reported inadequate LVO training and demonstrated gaps in knowledge of LVO, stroke severity scales, and stroke center levels. Systematic efforts to enhance and standardize the educational content and delivery of LVO education are urgently needed.
