Abstract Body: Background and Purpose: Prehospital recognition of stroke directly contributes to the reduction of mortality for stroke patients. Posterior circulation artery stroke (PCAS) continues to be a commonly missed vascular neurologic diagnosis in prehospital and emergency department settings nationally and worldwide. Furthermore, inaccurate last known well times (LKWT) can delay emergent stroke care. Goals for this project were to demystify PCAS symptoms for a select group of local prehospital providers, Beverly Hills Fire Department (BHFD), to improve their comfort level with PCAS symptom recognition, increase suspicion of stroke in patients with nebulous symptoms, and provide tools to improve accuracy of LKWT in the field.
Methods: We created a multimodal educational module consisting of an interactive lecture and two patient care simulation cases with class participation, focusing on PCAS. The class participants performed a pre- and post-class survey which included questions regarding information required for accurate last known well times (LKWT), PCAS symptoms and confidence scores for recognizing PCAS. A Likert scale of 0-5 was utilized for the confidence questions, zero being not at all confident and five being extremely confident. A QR code was used to access the survey and surveys were performed anonymously. We performed the same education for all three shifts at their home fire station.
Results: The question “which symptom is most likely related to a PCA stroke” had the most common pre-class answer of “dizziness” by a slim margin, followed by “aphasia” and “facial droop.” The most common post-class answer was “dizziness” by a large margin, followed by “aphasia.” There were no post-class answers of “facial droop.” The question of, “How confident are you with recognizing a patient with a posterior/cerebellar acute stroke?”: pre-class score was 2.79, post-class score was 3.96. The question of, “How confident are you with obtaining an accurate LKWT?”: pre-class score was 3.7, post-class score was 4.35.
Conclusions: Our targeted education improved PCAS symptom recognition and prehospital provider confidence for a differential of prehospital provider impression of stroke, with the most common PCAS symptom of “dizziness.” Confidence levels for accurate LKWT increased as well. Our hope is that increased confidence for our prehospital providers equates to increased disposition to certified stroke centers and improved stroke treatment times.