Educational Effect on Prehospital Personnel for Prehospital Stroke Management Jin Hyun Yoo, M.D., Eun Kyung Eo, M.D. 1, Yong Jae Kim, M.D. 2, Hwa Sik Song, M.D. P u r p o s e: If optimal neurologic recovery of stroke patients is to be achieved, thrombolysis and intervention must be initiated within hours from the onset of stroke symptoms. The prehospital personnel play a vital role in prehospital stroke management, including rapid recognition of stroke and rapid transport of the victim to the treating facility. The fact is, however, education and assessment of prehospital p e r s o n n e l s knowledge and practice in recognizing stroke are lacking. In this study, we assessed the prehospital p e r s o n n e l s knowledge of stroke; then, we performed an analysis to determine if that knowledge proved to have an impact on stroke management. M e t h o d s: The study was conducted from March to August 2001 at 9 fire stations in Seoul and other regional areas, and included 164 prehospital personnel. In order to conduct a before-and-after comparative study, we first investigated the prehospital personnel s current knowledge of stroke; then, we administered our own educational training which was taught by an emergency physician. R e s u l t s: One hundred sixty-four prehospital personnel participated in the educational training program. Most of them (63.4%) were educated at the National Fire Academy. The most frequently listed stroke risk factor was hypertension (98.2%). The most frequently listed stroke symptom and sign was 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 the education, their knowledge about the definition of stroke, its risk factors, symptoms and signs, the goal of prehospital management, and the therapeutic window for thrombolysis was not satisfactory. However, there was a significant improvement after the education(p<0.001). The extent of knowledge about stroke varied with the characteristics of the prehospital personnel. The prehospital p e r s o n n e l s knowledge was relatively higher if they were EMP-P certified; from the Department of Emergency Medical Service; worked in Seoul; had been educated for stroke; or had been less than 2 years on the job. C o n c l u s i o n: Presently, the prehospital personnel s knowledge about prehospital stroke management has proven to be insufficient. However, there was a significant improvement in stroke knowledge after education by an emergency physician Key Words: Stroke knowledge, Prehospital education, Prehospital personnel Department of Emergency Medicine, College of Medicine, Dankook University, Department of Emergency Medicine, College of Medicine, Ewha Womans University 1, and Department of Neurology, College of Medicine, Ewha Womans University 2 23
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/29 11. The National Institute of Neurologic Disorder and Stroke rt-pa Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333 : 1581-7, 1995.
30 / 12. American Heart Association Instructor s Manual. Advanced Cardiac Life Support: Acute ischemic stroke. C(10):1-53, 1997. 13. Easton JD, Hart RG, Sherman DG, Kaste: Diagnosis and management of ischemic stroke, I: threatened stroke and its management. Curr Probl Cardiol 8:1-76, 1983. 14. Engelstein E, Margulies J, Jeret JS: Lack of t-pa use for acute ischemic stroke in a community hospital: high incidence of exclusion criteria. Am J Emerg Med 18:257-60, 2000. 15.,,, : Stroke Scale: reproducibility and validity. Ann Emerg Med. 33:373-8, 1999. 11(3):296-304, 2000. 16. Fogelhoim R, Murros K, Rissanen A, Ilmarvirta M: Factor delaying hospital admission after acute stroke. S t r o k e 27:398-400, 1996. 17. Barsan WG, Brott TG, Broderic JP, Haley EC, Levy DE, Marler JR: Time of hospital presentation in patients with acute stroke. Arch Intern Med 153:2558-61, 1993. 18. Albert MJ, Perry A, Dawson DV, Bertels C: Effect of public and professional education on reducing the delay in presentation and referral of stroke patients. Stroke 23:352-6, 1992. 19. Clifton RL, Dong-Chul S, Maureen B, John BK: Delay in presentation and evaluation for acute stroke. Stroke Time Registry for Outcomes Knowledge and Epidemiology(S.T.R.O.K.E). S t r o k e 32:63-9, 2001. 10. Camarata PJ, Heros RC, Latchaw RE: Brain attack. the nationale for treating stroke as a medical emergency. Neurosurg 34:144-58, 1994. 11. American Heart Association Guideline 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Adult basic life support. I:22-59, 2000. 12. Kothari R, Hall K, Broderick J, Brott T: Early stroke recognition: developing an out-of-hospital stroke scale. Acad Emerg Med 4:986-90, 1997. 13. Kothari R, Pancioli A, Liu T, et al: Cincinnati Prehospital 14. Kidwell CS, Saver JL, Schubert GB, Eckstein M, Starkman S: Design and retrospective analysis of the Los Angeles Prehospital Stroke Screen(LAPSS). Prehosp Emerg Care 2:267-73, 1998. 15. Kidwell CS, Starkman S, Eckstein M, Weems K, Saver JL: Identifying stroke in the field : prospective validation of the Los Angeles Prehospital Stroke Screen(LAPSS). Stroke 31:71-6, 2000. 16. Grond M, Stenzel C, Schmulling S, et al.: Early intravenous thrombolysis for acute ischemic stroke in a communitybased approach. S t r o k e 29:1544-9, 1998. 17. Feldmann E, Gorsen N, Books JM, et al.: Factor associated with early presentation of acute stroke. S t r o k e 2 4 : 1 8 0 5-9, 1 9 9 3.