Helping paramedics recognize signs of stroke faster
When it comes to strokes, doctors have a mantra: time is brain. Delaying treatment even by minutes can mean the difference between a normal life and permanent disability, or even life and death.
That's why J. Adam Oostema, a Michigan State University College of Human Medicine associate professor of emergency medicine, led a study to shorten the time to treatment. Most hospitals already strive to reduce the "door to needle" time—the minutes between when a patient arrives, and doctors begin administering tPA, a clot-busting drug.
"The pre-hospital side was not getting as much attention," said Oostema, an emergency physician at Spectrum Health's Butterworth Hospital and the college's director of neurological emergency research.
In focus groups with paramedics, "we learned that paramedics wanted feedback," Oostema said. "They wanted to know what happened to the patients after they dropped them off."
So, he proposed training ambulance paramedics in Kent County, Mich. to recognize stroke symptoms and alert the hospitals and provide them with feedback on their performance. To help remind paramedics of the signs of stroke, they were taught to use the FAST prompt, which stands for facial drooping, arm weakness, speech difficulties and time.
The advanced notice could save valuable minutes by giving hospitals time to ready a CT scanner and assemble a specialized stroke team of doctors, nurses, pharmacists and technicians.
The study, funded by the American Heart Association and published in the journal Stroke, found that a brief online video helped the paramedics increase their recognition of stroke symptoms by 7 percent, improve hospital notification by nearly 17 percent and slightly increase the proportion of stroke patient who received tPA treatment within 45 minutes of arrival at the hospital.
However, the study also found that the improvements soon faded, suggesting that the paramedics needed occasional refresher courses and quicker feedback on how well they had recognized suspected strokes.
"Clearly, more needs to be done to reinforce and sustain the effect of the initial education," Oostema said.
With the help of Mathew Reeves, a College of Human Medicine epidemiologist, who helped design the study and analyze the data, both researchers are planning a broader, statewide study with a more-robust educational program.
The initial study included training programs for more than 400 Grand Rapids-area paramedics employed by Life EMS, AMR and Rockford Ambulance. The four Grand Rapids-area hospitals—Butterworth and Blodgett (both part of Spectrum Health), Metro Health and Saint Mary's Mercy Health Care—also participated.
The hospitals and ambulance companies "deserve a lot of credit for any gains that occurred," Oostema said. "It highlights how MSU can help organize multi-system studies like this."
He added that one of the challenges is not all stroke patients are the same. For patients suffering ischemic strokes, the most common form, tPA can dissolve a clot and minimize damage to brain tissue.
"The value of this study was it showed that paramedics are open to and benefit from even a brief training on this topic," Oostema said. "Every minute we can shave off the door-to-needle time, we can avoid damage that is irreversible. The difference could be living your life in a nursing home or going back home to your life."