Vol 6, No 2 (2021)
Research paper
Published online: 2021-05-31

open access

Page views 572
Article views/downloads 494
Get Citation

Connect on Social Media

Connect on Social Media

Profile of practices and knowledge on stroke among Polish emergency medical service staff

Natasza Blek12, Lukasz Szarpak23
Disaster Emerg Med J 2021;6(2):55-62.


BACKGROUND: Stroke is a leading cause of disability and death in both developed and developing countries. While hemorrhagic stroke often necessitates immediate neurosurgical intervention, ischemic stroke is treated with reperfusion therapies such as thrombolysis with intravenous recombinant tissue plasminogen activator (IV rtPA) and early endovascular thrombectomy for broad vessel occlusions.   OBJECTIVES: Early diagnoses, accurate emergency medical services (EMS) dispatch, rapid EMS transfer, and stroke team activation have helped reduce door-to-IV tPA time and continue to be critical in saving time for stroke patients’ treatment.   MATERIAL AND METHODS: One reason for prehospital delays may be incorrect qualification by emergency team members due to incomplete medical records and incorrect evaluation of symptoms by dispatchers or paramedics. The dispatcher’s precise identification of the report helps them decide on the patient’s priority disposal of the ambulance. In comparison, a correct initial diagnosis by paramedics allows the patient to be transported immediately to the destination hospital, i.e., the unit with a stroke unit. Extending the time it takes for the patient to enter the stroke facility due to the patient being moved through stages reduces the probability of successful treatment being introduced significantly.   RESULTS: We hypothesized that paramedics’ knowledge of prehospital stroke management protocols would be linked to their clinical experience as well as their stroke preparation.   CONCLUSION: A secondary goal of this study was to evaluate and compare the theoretical knowledge on stroke management among paramedics and identify factors associated with high knowledge. 468 EMS providers agreed to complete a questionnaire that included demographic questions, practical experience questions, and 14 theoretical information questions. Our research found that paramedics in Poland have significant awareness gaps in existing stroke treatment guidelines.

Article available in PDF format

View PDF Download PDF file


  1. Feigin VL, Norrving Bo, Mensah GA, et al. Global Burden of Diseases, Injuries and Risk Factors Study 2013 and Stroke Experts Writing Group, GBD 2013 Stroke Panel Experts Group, GBD 2013 Stroke Panel Experts Group, RIBURST Study Collaboration Writing Group. New strategy to reduce the global burden of stroke. Stroke. 2015; 46(6): 1740–1747.
  2. Benjamin E, Blaha M, Chiuve S, et al. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation. 2017; 135(10).
  3. Puolakka T, Kuisma M, Länkimäki S, et al. Cutting the Prehospital On-Scene Time of Stroke Thrombolysis in Helsinki: A Prospective Interventional Study. Stroke. 2016; 47(12): 3038–3040.
  4. Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021; 6(1): I–LXII.
  5. Aguiar de Sousa D, von Martial R, Abilleira S, et al. Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries. Eur Stroke J. 2019; 4(1): 13–28.
  6. Kobayashi A, Czlonkowska A, Ford GA, et al. European Academy of Neurology and European Stroke Organization consensus statement and practical guidance for pre-hospital management of stroke. Eur J Neurol. 2018; 25(3): 425–433.
  7. Meyran D, Cassan P, Avau B, et al. Stroke Recognition for First Aid Providers: A Systematic Review and Meta-Analysis. Cureus. 2020; 12(11): e11386.
  8. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019; 50(12): e344–e418.
  9. Jauch EC, Saver JL, Adams HP, et al. American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44(3): 870–947.
  10. Panchal AR, Berg KM, Cabañas JG, et al. 2019 American Heart Association Focused Update on Systems of Care: Dispatcher-Assisted Cardiopulmonary Resuscitation and Cardiac Arrest Centers: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2019; 140(24): e895–e903.
  11. Pepe PE, Zachariah BS, Sayre MR, et al. Ensuring the chain of recovery for stroke in your community. Chain of Recovery Writing Group. Prehosp Emerg Care. 1998; 2(2): 89–95.
  12. McClelland G, Rodgers H, Flynn D, et al. The frequency, characteristics and aetiology of stroke mimic presentations: a narrative review. Eur J Emerg Med. 2019; 26(1): 2–8.
  13. Hansson PO, Andersson Hagiwara M, Herlitz J, et al. Prehospital assessment of suspected stroke and TIA: An observational study. Acta Neurol Scand. 2019; 140(2): 93–99.
  14. H Buck B, Akhtar N, Alrohimi A, et al. Stroke mimics: incidence, aetiology, clinical features and treatment. Ann Med. 2021; 53(1): 420–436.
  15. Behrens S, Daffertshofer M, Interthal C, et al. Improvement in stroke quality management by an educational programme. Cerebrovasc Dis. 2002; 13(4): 262–266.
  16. Wojner-Alexandrov AW, Alexandrov AV, Rodriguez D, et al. Houston paramedic and emergency stroke treatment and outcomes study (HoPSTO). Stroke. 2005; 36(7): 1512–1518.
  17. Gorchs-Molist M, Solà-Muñoz S, Enjo-Perez I, et al. An Online Training Intervention on Prehospital Stroke Codes in Catalonia to Improve the Knowledge, Pre-Notification Compliance and Time Performance of Emergency Medical Services Professionals. Int J Environ Res Public Health. 2020; 17(17).
  18. Hsieh HC, Hsieh CY, Lin CH, et al. Development of an educational program for staffs of emergency medical service to improve their awareness of stroke within 3 hours of symptom onset: a pilot study. Acta Neurol Taiwan. 2013; 22(1): 4–12.
  19. Shire F, Kasim Z, Alrukn S, et al. Stroke awareness among Dubai emergency medical service staff and impact of an educational intervention. BMC Res Notes. 2017; 10(1): 255.