Emergency Medical Services Education, Community Outreach, andProtocols for Stroke andChest Pain in North Carolina

Abstract

Objective. Prehospital care of stroke andchest pain patients is dependent on adequate emergency medical services (EMS) education andevidence-based protocols. We sought to describe the amount of education offered, community outreach implemented, andprotocols established for stroke andfor chest pain among North Carolina EMS agencies andpersonnel. Methods. A survey was developed to measure EMS system characteristics regarding the prehospital care of stroke andchest pain patients. Each of the 83 primary EMS agencies in North Carolina was asked to participate. Results. Of the 83 agencies surveyed, 72 (87%) responded. Both advanced life support (ALS) andbasic life support (BLS) services were provided by 54% of agencies; 44% offered ALS only and1% offered BLS only. While 89% of the EMS agencies provided stroke education to EMS personnel and96% chest pain education to EMS personnel in the previous two years, the median hours devoted to stroke was one-half that for chest pain (6.0 vs. 12.0 hours, respectively). In the previous six months, 14% of EMS agencies had conducted community outreach programs for stroke compared with 17% for chest pain. The majority of EMS agencies had protocols specifically for managing stroke (83%) andfor managing chest pain (99%). Diagnostic scales to identify stroke patients were used by 54% of agencies (20% Los Angeles Prehospital Stroke Screen, 20% Cincinnati Prehospital Stroke Scale, and14% a locally developed scale). Thrombolytic checklists were used to identify eligible stroke patients at 37% of the EMS agencies, compared with 28% for eligible chest pain patients. Conclusions. In North Carolina, primary EMS agencies appear to have stroke andchest pain protocols in approximately the same frequency, yet their personnel receive only one-half as much education about stroke as they do about chest pain. Many stroke protocols were lacking basic components andwould benefit from standardization across the state. Community outreach programs for both stroke andchest pain are minimal.