EMS programs improve stroke awareness, short-term

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Community stroke education programs developed by emergency medical services (EMS) personnel help increase people’s knowledge about the warning signs and symptoms of stroke, and are relatively inexpensive to implement, new research from West Virginia shows.

But when the interventions end, knowledge declines, and these interventions also didn’t increase awareness of stroke risk factors or the need to call 911 if someone seems to be having a stroke, Stephen M. Davis of West Virginia University in Morgantown and his colleagues found.

Clot-dissolving or thrombolytic drugs available since 1996 can help reduce damage after stroke, but must be given within a short time after a stroke occurs, Davis and his team note in the June issue of Stroke. In fact, they add, just 2 percent to 6 percent of stroke patients who could benefit from such therapies actually get them.

"The reason why we came up with this idea was because a lot of the literature shows that you can teach the public about stroke signs and symptoms,” Davis told Reuters Health. While mass media programs to improve knowledge about stroke have had some success, he added, these programs are very expensive; some communities spend upwards of $1 million on print and broadcast public service announcements. “In West Virginia, most of our communities don’t have a million dollars,” the researcher added.

Davis and his colleagues investigated whether it might be possible to deliver this information in a less costly way by working with local EMS personnel. In the first phase of their two-part study, they offered an educational course to EMS personnel in a single county, after which EMS workers broke into small groups and came up with ideas for 10 different educational materials to increase stroke awareness and 15 “strategic community locations” for placement of the information.

In the second phase, the researchers enrolled EMS personnel from four counties in the program and had four more counties serve as controls. Each of the intervention counties received $5,000 to help pay for educational materials, with instructions to make these materials reusable if possible.

Interventions the EMS personnel developed included posters put up in malls, pharmacies and tobacco shops and on city buses; a TV spot produced with the help of a local hospital; stroke awareness events; and strategies for distributing information at other community functions.

For phase 1, the researchers surveyed a total of 724 people about stroke signs and symptoms, stroke risk factors, and the need to call 911 before the intervention. The survey was repeated four more times during the following two years.

In the second phase, they surveyed 1,193 people in the control counties and 1,182 people in the counties where EMS personnel conducted stroke awareness programs.

After phase 1, the researchers observed an initial increase in awareness of warning signs and symptoms of stroke, followed by a decline after the intervention was over.

After phase 2, people living in the intervention counties were more likely to be able to name two stroke risk factors and three symptoms after the intervention, while awareness stayed the same or declined in the control counties. But there was no evidence that the interventions improved knowledge of the need to call 911.

Davis pointed out that other public service campaigns have also had a tough time increasing awareness of the need to call 911. “That is a nut so to speak that we’re still trying to crack,” he said. “That’s something that is unfortunately not unique to our study.”

This is crucial, he added, because every minute counts; tissue plasminogen activator, the drug used to dissolve clots, must be given within 3 hours of a stroke, and patients must have a CT scan before the drug is administered to ensure that the stroke is the results of a clot, not a hemorrhage.

Just going to the emergency room on one’s own can mean potentially deadly delays, according to Davis.

“You’ve got to know what it looks like, and you’ve got to understand that the only right answer is call 911,” he said. Davis noted that the Brain Attack Coalition is planning to release a new slogan to get the word out: “Stroke strikes fast. You should too. Call 911.”

The post-intervention decline in knowledge, also seen with other stroke awareness programs, makes it clear that any program will need to be recurrent to be effective, he added.

SOURCE: Stroke, June 2009.

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