An interventional study to improve paramedic diagnosis of stroke.

OBJECTIVE: The aim of the Faster Access to Stroke Therapy (FAST) study was to determine the effect of educational intervention and the use of a prehospital stroke tool on the paramedic diagnosis of stroke.
METHODS: Paramedics in emergency medical service units servicing a university teaching hospital were divided into two groups: FAST study paramedics (n = 18) and non-FAST study paramedics (n = 43). The FAST study paramedics received stroke education and instruction in the use of a prehospital stroke assessment tool [Melbourne Ambulance Stroke Screen (MASS)] to assist in stroke diagnosis. Based on final hospital diagnosis, the sensitivities of paramedic stroke diagnosis in the two groups were compared for a 12-month period before and after the intervention.
RESULTS: The sensitivity for the FAST study paramedics in identifying stroke improved from 78% (95% confidence interval [CI]: 63% to 88%) to 94% (95% CI: 86% to 98%) (p = 0.006) after receiving the stroke education session and with use of the MASS tool. There was no change in stroke diagnosis for the non-study paramedics 78% (95% CI: 71% to 84%) to 80% (95% CI: 72% to 87%) (p = 0.695). Pre-notification of impending arrival to the emergency department was associated with higher-priority triage in the emergency department, and subsequent shorter times for door to medical review (15 min vs. 31 min, p < 0.001) and door to computed tomography (CT) scanning (94 min vs. 144 min, p < 0.001).
CONCLUSIONS: Targeted stroke education and the use of a simple clinical tool can significantly improve the diagnostic sensitivity of stroke by paramedics in the prehospital setting. Accurate diagnosis combined with pre-notification of the pending arrival of stroke patients will allow for the focused and timely application of resources for the management of acute stroke.