Effects of Training Paramedics on Prehospital Stroke Management

Abstract

For optimal neurologic recovery in stroke patients, the use of thrombolytics and intervention must be initiated within hours after the onset of stroke. Thus, medical personnel, i.e., paramedics, involved before the patient arrives at the hospital plays a vital role in prehospital stroke management, including early recognition of stroke and rapid transport of the victim to the treating facility. The fact is, however, training in paramedics to recognize stroke patients and assessment of these paramedics on their knowledge about stroke are lacking. We assessed the extent of paramedics' knowledge about stroke and analyzed whether training paramedics about stroke would have an impact. The study was conducted from March to August, 2001 at 9 different fire stations in Seoul and other regional areas in 164 paramedics. In order to conduct a before-and-after comparative study, we firstly investigated the extent of current knowledge on stroke in these paramedics. Then, these paramedics were then trained by 3 different emergency specialists who taught the same content on basic information of stroke including the definition, signs and symptoms of stroke and how to recognize stroke. Among 164 paramedics who participated in our educational training program, most (63.4%) were trained at the National Fire Academy. The most frequently listed stroke risk factor was hypertension (98.2%). The most frequently listed stroke symptom and sign were abnormal speech (91.5%). The level of knowledge about the prehospital stroke scale was very low (facial palsy: 10.8%, arm drift: 7.9%, dysarthria: 17.7%). Before training, their knowledge on the definition of stroke, its risk factor; symptoms and signs, the goals of prehospital management and the therapeutic window for thrombolysis were not sufficient. However, a significant improvement was seen in the extent of knowledge through training (p<0.001). The extent of knowledge about stroke was different according to the characteristics of paramedics. The extent of stroke knowledge was relatively higher in those who had an EMP-P certification, majored in emergency medical service, worked in Seoul, underwent training on stroke; or hard work experience as a paramedic less than 2 years. The present study proves that paramedics lack knowledge about prehospital stroke management. However, a significant improvement was seen in paramedics after training in their knowledge on stroke.