Abstract
Background There are a large number of stroke patients in China, and there is currently a lack of prehospital acute stroke care training programs. Aim To develop a prehospital emergency medical service (PEMS) training program to improve the prehospital identification and acute care of acute stroke. Methods Forty prehospital emergency doctors whose service stations are located within a 10 km radius from Shanghai Pudong New Area Medical Emergency Service Center took this course on November 13, 2014. A questionnaire was designed to evaluate the PEMS personnel's knowledge in stroke and acute stroke care and was conducted before and after training as an assessment of the effectiveness of training. The patient population in this study included a baseline cohort before training and a prospective cohort after training, each composed of patients who were sent to Shanghai East Hospital South Stoke Center within one year. The transit time, final diagnosis, administration of thrombolysis, and door-to-needle time (DNT) were collected and analyzed. Results After the training, 100% of the PEMS personnel were competent to identify stroke cases using the Cincinnati prehospital stroke scale (CPSS). All participants realized that intravenous thrombolysis therapy in a time-sensitive manner is the most effective way to treat acute ischemic stroke. Although there was no difference in first-aid transit time before and after training, the stroke diagnosis rate improved by 6.5% after training (P=0.03). The thrombolysis rate increased to 29.6% from 24.3% but did not reach statistical significance. Compared to 84.0 minutes (standard deviation: 23.1 minutes) before the training, the average DNT after training was 53 minutes (standard deviation: 15.0 minutes), demonstrating a remarkable reduction (P < 0.01). Conclusion The training program effectively improved the PEMS personnel's knowledge in stroke and stroke acute care.
Highlights
Introduction e Chinese National Center forCardiovascular Disease reported that there were 13 million stroke patients in 2018 [1]
prehospital emergency medical service (PEMS) Training Program. e training materials were adapted from 2010 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science Part II: Adult Stroke [12], with a focus on critical care 1 hour before the hospital admission. e materials included a textbook for trainees, an instructor’s book, and 25-minute videos, which covered the basic knowledge of stroke and stroke-related prehospital acute care. e training process included three sessions, with a combination of video learning, group discussion, and quiz
Each discussion was about 3 topics from the following list: 1) the clinical presentation, signs, and symptoms of acute stroke; 2) type of stroke; 3) how to identify the type of stroke in earlystage; 4) identify acute stroke by PEMS using the Cincinnati prehospital stroke scale (CPSS); 5) why should the patient be sent to the nearest stroke center? 6) what examination should be performed during transportation? 7) why is it critical to communicate with the emergency department in the hospital earlier? 8) how to contact with stroke center? 9) what should be reported in the stroke center, such as intravenous thrombolytic time window, indications, and contraindications
Summary
E training process included three sessions, with a combination of video learning, group discussion, and quiz. Participants of the training program were open to all emergency doctors from service stations within a 10 km radius from Shanghai Pudong new area medical emergency service center, including 8 suburban stations: Zhoujiadu station, Yangsi station, Zhoupu station, Punan station, Northcai station, Sanlin station, Cambridge substation, and Renji substation. Five emergency doctors from each station, including the captain, eventually joined the training program. All these 40 emergency doctors have a medical degree, board certificate, and 1 to 8-year experience in PEMS. E instructors are vascular neurologists from Shanghai east hospital south stroke center, who are certified AHA ACLS course directors. Student’s t-test or Chi-square test was used for precomparison and postcomparison, as appropriate
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