Introduction Endovascular thrombectomy (EVT) has become the standard of care for large vessel occlusion (LVO) strokes over the past decade. Prehospital recognition of stroke signs and symptoms by Emergency Medical Services (EMS) personnel is critical for prompt identification of suspected LVO strokes. The American Heart Association (AHA) and American Stroke Association (ASA) Mission Lifeline algorithm recommends severity‐based EMS triage to EVT‐capable centers. Our objective is to assess the current state of prehospital stroke education and implementation of the AHA/ASA destination triage guidelines. Methods The Society of Vascular and Interventional Neurology (SVIN) developed a survey about EMS stroke education that was distributed to the Metropolitan EMS Medical Directors (also known as the “Eagles”) Alliance, collectively accountable for about one‐third of the United States population. The survey had questions about duration and frequency of stroke training, topics covered, barriers for teaching, type of setting (urban, suburban, rural), stroke severity scales utilized, bypass protocols, and challenges to implementation. Results The response rate was 96% (48/50), capturing United States EMS agencies from 23 states and Washington, D.C. Total educational hours provided to EMS personnel ranged from 36 to 48 hours per year and stroke was among the top five medical conditions covered by 96.5% of respondents. The top three topics covered for initial stroke education included: 1) screening scales, 2) types of stroke centers, and 3) LVO assessment scales, respectively. The total hours of stroke education ranged from 1‐4 hours (83.4%). 50.1% of respondents used AHA/ASA resources, and the other half reported a wide variety of sources, including education specific to their regions. Approximately 55% of respondents stated lack of time for implementation of education, and 23.1% indicated cost as a barrier. Most respondents indicated oversight of multiple EMS agencies, and had implemented triage guidelines among their agencies. The top 3 stroke severity scales used were the Cincinnati Prehospital Stroke Scale, VAN, and FAST‐ED, respectively. The majority (60.6%) did not have protocols to specify maximum transport times to a thrombectomy‐capable or comprehensive stroke center for LVOs. Guideline implementation challenges included existing statewide protocols, proximity to multiple stroke centers, and concerns about the accuracy of stroke severity scales. Nearly half (45.9%) experienced hospital pushback to these triage protocols due to over/under triage concerns and 52.7% stated data transparency would better facilitate implementation of stroke triage guidelines. Conclusion Most EMS medical directors in large cities are familiar with prehospital stroke education and the AHA/ASA destination triage guidelines. They largely offer dedicated, albeit often brief, stroke education, which is primarily limited by time and cost constraints. Varied use of stroke severity scales and protocols was attributed to existing statewide policies, proximity to stroke centers, concerns regarding scale accuracy, hospital pushback, and the need for greater data transparency to facilitate guideline implementation.
Pepe et al. (Sat,) studied this question.