The extended time window for mechanical thrombectomy in acute stroke has added additional challenges to rural regions. Given the topography of the Appalachian region, much of the initial treatment time windows are spent with emergency medical service (EMS) personnel. Few centers in our region are equipped to treat large vessel ischemic strokes and transferring between centers leads to substantial delays and lost treatment opportunities. Now more than ever, EMS providers must understand how to recognize stroke symptoms, know the treatment time windows, and acquire vital pieces of the medical history in order to facilitate appropriate and timely care.

We provided basic stroke education to rural EMS providers during the months of August 2017 to May 2018. An eight-question previously validated survey was given prior to and immediately after the education session. Questions included stroke intervention options and time windows, identification of blood thinners, and stroke prevalence and symptoms. Answers were confidential and participates had between 0 and 50 years of experience. In total, 61 pre-surveys and 63 post-surveys were completed.

A Wilcoxon signed-rank test showed that the education program elicited a statistically significant change in stroke knowledge for EMS providers (Z = -4.013, p <.001). Median percentage was 57.1 before education and 71.4 after. The question with largest improvement in pre to posttest scores, 44 to 71 percent correct (p=.002), was recognition of stroke symptoms.