title: An interventional study to improve paramedic diagnosis of stroke.
abstract: OBJECTIVE
  The aim of the Faster Access to Stroke Therapy (FAST) study was to determine the effect of educational intervention and the use of a prehospital stroke tool on the paramedic diagnosis of stroke.
  
  
  METHODS
  Paramedics in emergency medical service units servicing a university teaching hospital were divided into two groups: FAST study paramedics (n = 18) and non-FAST study paramedics (n = 43). The FAST study paramedics received stroke education and instruction in the use of a prehospital stroke assessment tool [Melbourne Ambulance Stroke Screen (MASS)] to assist in stroke diagnosis. Based on final hospital diagnosis, the sensitivities of paramedic stroke diagnosis in the two groups were compared for a 12-month period before and after the intervention.
  
  
  RESULTS
  The sensitivity for the FAST study paramedics in identifying stroke improved from 78% (95% confidence interval [CI]: 63% to 88%) to 94% (95% CI: 86% to 98%) (p = 0.006) after receiving the stroke education session and with use of the MASS tool. There was no change in stroke diagnosis for the non-study paramedics 78% (95% CI: 71% to 84%) to 80% (95% CI: 72% to 87%) (p = 0.695). Pre-notification of impending arrival to the emergency department was associated with higher-priority triage in the emergency department, and subsequent shorter times for door to medical review (15 min vs. 31 min, p < 0.001) and door to computed tomography (CT) scanning (94 min vs. 144 min, p < 0.001).
  
  
  CONCLUSIONS
  Targeted stroke education and the use of a simple clinical tool can significantly improve the diagnostic sensitivity of stroke by paramedics in the prehospital setting. Accurate diagnosis combined with pre-notification of the pending arrival of stroke patients will allow for the focused and timely application of resources for the management of acute stroke.
authors.affiliation: Eastern Melbourne Neurosciences, Deakin University, Victoria, Australia.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Bray
authors.forename: Jenepher
authors.initials: J
authors.lastname: Martin
authors.forename: Greg
authors.initials: G
authors.lastname: Cooper
authors.forename: Bill
authors.initials: B
authors.lastname: Barger
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.forename: Christopher
authors.initials: C
authors.lastname: Bladin
mesh_terms: D000368:Aged; D002983:Clinical Competence; D015331:Cohort Studies; D004496:Education, Continuing; D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012680:Sensitivity and Specificity; D020521:Stroke / Q000145:classification / Q000175:diagnosis*; D014218:Triage / Q000379:methods; D014739:Victoria