Date of Award

January 2019

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Jessica Coviello

Abstract

ABSTRACT

Introduction: Studies show that up to 30% of acute stroke patients brought to the emergency department (ED) are diagnosed with a stroke mimic. With more stroke systems adopting a prehospital large vessel occlusion (LVO) stroke scale that includes bypass protocol, it is imperative that emergency medical service (EMS) personnel be educated on how to implement the scale, identify stroke mimics, and accurately determine the time of last known well. Studies show that LVO stroke scales demonstrated low specificity when scored by EMS personnel, as compared to those scored by physicians. In 2018 the Massachusetts Office of EMS updated the protocol for acute stroke by implementing the FAST-ED scale. without requiring formal education on the new assessment items.

Purpose: To develop and present an evidence-based, expert validated educational module for Massachusetts EMS on FAST-ED assessment items, common stroke mimics, and determining the time of last known well.

Methods: A didactic and experiential scenario-based educational module was developed following a literature search that included the FAST-ED scale, stroke mimics, and EMS Education. A panel of neurology and EMS experts validated the module, pre and post-test, and the delivery method. Three Western Massachusetts fire departments participated in the Beta Test which included the module presentation with pre and post-tests. Two of the departments participated in post-module focus groups for feedback.

Results: Fifty-six paramedics from three fire stations participated in the Beta Test. Analysis of the test result data showed that there was a significant difference in the educational module pre-test (M=5.4, SD1.14) and post-test (M=9.4, SD1.14) scores; t(4)=-5.66, p=0.005.

Conclusion: A formal acute stroke education program for prehospital personnel could help increase the efficacy and utility of the newly implemented FAST-ED stroke scale.

Keywords: FAST-ED, prehospital education, acute stroke, large vessel occlusion

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