Objective:

To study the impact of an interactive neurological emergencies (NE) curriculum for first responders (FRs) in a neurologically underserved community. 

Background:

Despite their critical, initial role in patient management, FRs do not receive as extensive training in approach to NEs as clinicians in other disciplines.  

Design/Methods:

An interprofessional team of neurologists, Emergency Medical Services leaders, and a stroke coordinator implemented a NE curriculum for FRs in Victoria, Texas. Case-based discussions, simulation, and gamification were leveraged to teach dizziness/syncope, traumatic brain injury (TBI), stroke, seizure, headache, encephalopathy, and spinal cord and neuromuscular emergencies. Five synchronous in-person sessions were conducted between 10/2023-7/2024. FR self-reported familiarity with NE topics was assessed pre and post curricular implementation. FR completed pre-post knowledge assessments for individual sessions and the entire course. Monthly clinical metrics including aggregate door-to-needle-times, incidence of both thrombolytic administration, and transfer for thrombectomy for acute stroke patients were collected from a local community hospital.

Results:

There were 174 attendances, averaging 24 learners/session. We observed a nonsignificant increase in proportion of participants reporting “a moderate amount” and “a lot” of familiarity of NEs (p=0.83). Pre-post knowledge assessment scores improved for stroke, spinal cord and neuromuscular emergencies, and TBI and headache sessions (p<0.01, each). Scores did not significantly differ for the other NE topics(p=0.12) nor for the overall course (p=0.97). Locally, we noted a significant increase in tPA administration incidence (p=0.02), although no change in transfer for thrombectomy (p=0.11) nor door-to-needle-times (p=0.34) over time.  

Conclusions:

Our pilot study supports feasibility of an NE curriculum for FRs. This intervention may improve familiarity with NEs and short-term learning for FRs, and potentially improve their recognition of acute stroke therapy candidates. Findings are limited by sample size. Larger scale studies in different settings will better characterize generalizability and implications of dedicated FR NEs education on prehospital workflow and clinical outcomes.