Profile of practices and knowledge on stroke among Polish emergency medical service staff

Abstract

BACKGROUND:Stroke is a leading cause of disability and death in both developed and developing countries. While hemorrhagic stroke often necessitates immediate neurosurgical intervention, ischemic stroke is treated with reperfusion therapies such as thrombolysis with intravenous recombinant tissue plasminogen activator (IV rtPA) and early endovascular thrombectomy for broad vessel occlusions. OBJECTIVES:Early diagnoses, accurate emergency medical services (EMS) dispatch, rapid EMS transfer, and stroke team activation have helped reduce door-to-IV tPA time and continue to be critical in saving time for stroke patients' treatment. MATERIAL AND METHODS:One reason for prehospital delays may be incorrect qualification by emergency team members due to incomplete medical records and incorrect evaluation of symptoms by dispatchers or paramedics. The dispatcher's precise identification of the report helps them decide on the patient's priority disposal of the ambulance. In comparison, a correct initial diagnosis by paramedics allows the patient to be transported immediately to the destination hospital, i.e., the unit with a stroke unit. Extending the time it takes for the patient to enter the stroke facility due to the patient being moved through stages reduces the probability of successful treatment being introduced significantly. RESULTS:We hypothesized that paramedics' knowledge of prehospital stroke management protocols would be linked to their clinical experience as well as their stroke preparation. CONCLUSION:A secondary goal of this study was to evaluate and compare the theoretical knowledge on stroke management among paramedics and identify factors associated with high knowledge. 468 EMS providers agreed to complete a questionnaire that included demographic questions, practical experience questions, and 14 theoretical information questions. Our research found that paramedics in Poland have significant awareness gaps in existing stroke treatment guidelines.

Knowledge of acute stroke management and the predictors among Malaysian healthcare professionals

“…For HSM-1 ( Stroke is a medical emergency only within 4.5 h of stroke onset ), 70% of our participants were unaware of thrombolysis above 4.5 h. Intravenous thrombolysis can also be considered for acute stroke onset more than 4.5 h up to 9 h or in wake-up stroke or stroke of uncertain onset assisted by CT/MR perfusion (significant penumbra mismatch) or MRI (DWI-FLAIR mismatch) ( Academy of Medicine of Malaysia, 2021 ). Our finding is similar to that reported previously, especially regarding the treatment of extended hours of stroke; most participants were unaware of stroke treatment beyond 4.5 h ( Blek & Szarpak, 2021 ). Thus, potentially treatable stroke patients could be missed due to poor knowledge.…”

“…This study found that HCPs who saw stroke patients in daily practice, especially doctors and those working with specialists, had better overall knowledge of stroke, showing that experience and proper guidance are the determinant factors of stroke knowledge. Similarly, previous studies reported that being a physician ( Rababah, Al-Hammouri & AlNsour, 2021 ), working in a stroke-related speciality ( Mellon et al, 2015 ), and seeing more stroke cases ( Blek & Szarpak, 2021 ), are significantly associated with higher stroke knowledge. Furthermore, training, skill, and expertise in acute stroke care were significantly associated with higher thrombolysis rates ( Paul et al, 2015 ).…”

“…Elevated BP after a stroke should be carefully lowered to at or below 185/110 mmHg before the initiation of acute therapy; otherwise, it should not be treated in acute stroke patients below 220/120 mmHg ( Academy of Medicine of Malaysia, 2021 ). Previously, it was reported that 80% of paramedics were not managing hypertension according to guidelines ( Blek & Szarpak, 2021 ). Another study reported that 62.6% of stroke patients were over-treated with anti-hypertensive ( Haidar et al, 2021 ).…”

“…The target population of the studies has mainly been general practitioners, paramedics, and emergency nurses. Previous studies had a wide variation in HCPs’ responses to the stroke knowledge questions, and most of them recommended stroke education to improve their knowledge ( Lin et al, 2017 ; Shahzad et al, 2018 ; Yeganeh et al, 2019 ; Chang et al, 2020 ; Blek & Szarpak, 2021 ; Kusuma et al, 2021 ).…”

“…Years of clinical experience ( Lin et al, 2017 ; Chang et al, 2020 ; Blek & Szarpak, 2021 ; Kusuma et al, 2021 ), profession ( Rababah, Al-Hammouri & AlNsour, 2021 ), working in stroke-related specialities ( Mellon et al, 2015 ), the number of beds ( Yeganeh et al, 2019 ), and the number of stroke cases ( Blek & Szarpak, 2021 ) were known to be associated factors of stroke management knowledge. However, previous studies did not explore factors such as the work sector (government vs private), work settings (hospital vs primary care clinic), and the presence of guidance from specialists.…”