To improve recognition and identification of atypical stroke presentations by EMS.

The curriculum involves a lecture with 5 cases discussing presentations of posterior circulation stroke, that was preceded and followed by a survey. A 3-point Likert scale was utilized to assess comfort levels of EMS. Wilcoxon rank sum tests were performed on the null hypothesis to examine the effect of education on comfort levels as implemented in R (R version 3.5.3).

Eighty pre- and post-education surveys were included in the analysis. More individuals in the post-lecture group felt comfortable recognizing basilar artery occlusion stroke, stroke syndromes that could present as altered mental status or lethargy/somnolence, and cranial nerve deficits as brainstem stroke presentations compared to individuals in the pre-lecture group (p<0.05). More individuals in the post-lecture group felt comfortable recognizing visual symptoms as stroke presentations compared to individuals in the pre-lecture group though the difference in distributions in the two groups did not differ significantly (W= 2854.4, p=0.08). 

In conclusion, our education strategy highlighted atypical stroke presentations that may be missed using conventional pre-hospital scales and resulted in statistically significant increased comfort levels among EMS abilities to recognize various atypical stroke symptoms. Visual symptoms did not increase significantly which was likely due to high comfort levels among EMS at baseline. This lecture was delivered both in-person and virtually, reflecting ease of our implementation strategy. Future work will evaluate the efficacy of our strategy by comparing acute stroke presentations associated with inaccurate EMS identification before and after intervention in our region.