title: Stroke knowledge among urban and frontier first responders and emergency medical technicians in Montana.
abstract: OBJECTIVE
  To assess stroke knowledge and practice among frontier and urban emergency medical services (EMS) providers and to evaluate the need for additional prehospital stroke training opportunities in Montana.
  
  
  METHODS
  In 2006, a telephone survey of a representative sample of EMS providers was conducted in Montana. Respondents were stratified into 2 groups: those working in urban and frontier counties.
  
  
  RESULTS
  Compared to EMS providers from urban counties, those from frontier counties were significantly more likely to be older (mean age 44.7 vs 40.1 years), have fewer personnel working in their service (mean 17.7 vs 28.6), to be located farther away from a computed tomography scan (CT scan) (mean 41.3 vs 17.6 miles), and to be volunteers (84% vs 49%). They were also less likely to have a stroke protocol (58% vs 66%) and use a stroke screening tool (36% vs 47%) than their urban counterparts. There were no significant differences between frontier and urban EMS respondents' ability to correctly identify 4 or more stroke warning signs (58% vs 61%), 4 or more stroke risk factors (46% vs 43%), or the 3-hour recombinant tissue plasminogen activator (rt-PA) treatment window (56% vs 57%). Approximately two thirds of respondents from urban and frontier counties believed they had adequate stroke knowledge, but 90% indicated they were interested in additional stroke-related training.
  
  
  CONCLUSIONS
  Although stroke knowledge did not differ between urban and frontier groups, stroke screens and stroke protocols were less likely to be used in the frontier areas. Training opportunities and the implementation of stroke protocols and screening tools are needed for EMS providers, particularly in frontier counties.
authors.affiliation: Montana Cardiovascular Health Program, Montana Department of Public Health and Human Services, Helena, MT 59620-2951, USA. mmcnamara@mt.gov
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McNamara
authors.forename: Carrie
authors.initials: C
authors.lastname: Oser
authors.forename: Dorothy
authors.initials: D
authors.lastname: Gohdes
authors.forename: Crystelle C
authors.initials: CC
authors.lastname: Fogle
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Dietrich
authors.forename: Anne
authors.initials: A
authors.lastname: Burnett
authors.forename: Nicholas
authors.initials: N
authors.lastname: Okon
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Russell
authors.forename: James
authors.initials: J
authors.lastname: Detienne
authors.forename: Todd S
authors.initials: TS
authors.lastname: Harwell
authors.forename: Steven D
authors.initials: SD
authors.lastname: Helgerson
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009009:Montana; D019035:Rural Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D019037:Urban Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator