Paramedics Skilled in Identifying Strokes -- MEDICA - World Forum for Medicine

Paramedics Skilled in Identifying Strokes

"If a paramedic thinks a patient is having a stroke, that should be a reliable indicator that the hospital's stroke team should be activated," said Doctor Michael Schneck of the American Academy of Neurology in New Orleans.

Doctor Mark Cichon, who heads Loyola's emergency room, said the findings illustrate that paramedics "are very well trained in stroke recognition." He added that stroke is one of many emergency conditions in which paramedics are trained to initiate treatment before the patient arrives at the hospital.

Most strokes are caused by blood clots in the brain. If given promptly, the clot-busting drug tPA, in certain cases, can dissolve the clot and stop the stroke before it causes permanent damage. But before tPA is given, a patient must undergo a CT scan to confirm the stroke is caused by a clot. About 15 per cent of strokes are caused by bleeding in the brain. In such cases, administering tPA could make strokes worse.

Since every minute counts, hospitals are striving to reduce the "door-to-needle" time - the length of time it takes from when a stroke patient arrives at the emergency room door until the patient is given intravenous tPA. One way Loyola is cutting times is by having the ambulance radio ahead when it is bringing in an apparent stroke patient. Loyola's stroke team then is activated and ready to go into action as soon as the patient arrives, Cichon said.

In the study, Loyola researchers reviewed the records of 5,300 patients who were transported by EMS to Loyola between October 1, 2010, and June 30, 2011. While the EMS specificity rate in identifying strokes was 99.3 per cent, the sensitivity rate was only 51 per cent. In other words, when paramedics suspected patients were having strokes, they were probably correct - but they also missed many cases. Of the 96 actual strokes, paramedics correctly identified 49 cases, but missed 47. Paramedics were most likely to miss strokes in patients younger than 45.; Source: Loyola University Medical Centre