3 reactions to EMS1 stroke poll

EMS providers give a glimpse into how they think about, assess, and treat stroke

July 13, 2015 10:51 AM •

I like how these polls show us a glimpse into what we think and a little bit of how we act. It also points out areas in which we can improve.

Here are my take-home points from the EMS1.com poll on stroke assessment and treatment.

1. Overconfident assessment

We are a bit overconfident about identifying stroke. Ninety-four percent seem to agree or strongly agree with the statement that they can identify stroke. I agree that we can identify most of the easily recognized strokes.

But do we do a differential diagnostic approach to altered mental status and catch non-traditional strokes, such as strokes in those less than 50-years-old? I don’t think we are there yet. Stroke scales are accurate, but they only work if we think to use them.

2. Failure on several fronts

I’m also disappointed in the results in which more than 60 percent of respondents seem to believe “all stroke patients should receive oxygen.” I think this is a failure on several fronts. It is a failure of education to not teach AHA guidelines that have been out since late 2010. It is a failure of agencies and individuals to not keep up with current standards of care. And it is a failure to choose tradition and what feels good over mounting science.

What I find interesting is that everyone is jumping on the reduced use of backboards trend because it is convenient and intuitive, yet the current science strongly supports the reduced use of oxygen and we still fight against that change. We can’t just choose the changes in practice we like or the ones that are the most convenient.

3. Readiness for clinically challenging patients

I am happy that we routinely use stroke scales, blood glucose monitors and that we know to ask about when the symptoms of stroke began. What I question is whether we know how to treat the patient who has signs and symptoms of stroke and a blood glucose of 62 mg/dL. Patients who pose clinical challenges will determine how we truly think and function.

Finally, I believe this poll shows we have come a long way. It also shows we have a long way to go.

What do you think?

Dan Limmer

Dan Limmer is a paramedic, educator and police officer who has been involved in public safety for more than 35 years. He has authored more than a dozen EMS textbooks including the Emergency Care textbook and is a frequent international conference speaker. He is the Chief Knowledge Officer at Limmer Education, a company he co-founded to publish high quality study and test prep programs. Limmer is a member of the EMS1 Editorial Advisory Board.