Using G-FAST to recognize emergent large vessel occlusion: a training program for a prehospital bypass strategy

J Neurointerv Surg. 2020 Jan;12(1):104-108. doi: 10.1136/neurintsurg-2019-015171. Epub 2019 Jul 23.

Abstract

Introduction: The shorter the time between the onset of symptoms and reperfusion using endovascular thrombectomy, the better the functional outcome of patients. A training program was designed for emergency medical technicians (EMTs) to learn the gaze-face-arm-speech-time test (G-FAST) score for initiating a prehospital bypass strategy in an urban city. This study aimed to evaluate the effect of the training program on EMTs.

Methods: All EMTs in the city were invited to join the training program. The program consisted of a 30 min lecture and a 20 min video which demonstrated the G-FAST evaluation. The participants underwent tests before and after the program. The tests included (1) a questionnaire of knowledge, attitudes, confidence, and behaviors towards stroke care; and (2) watching 10 different scenarios in a video and answering questions, including eight sub-questions of G-FAST parameters, and choosing a suitable receiving hospital.

Results: In total, 1058 EMTs completed the training program. After the program, significant improvement was noted in knowledge, attitudes, and confidence, as well as scenario judgement. The performance of the EMTs in evaluating G-FAST criteria in comatose patients was relatively poor in the pre-test and improved significantly after the training course. Although the participants answered the G-FAST items correctly, they tended to overtriage the patients and refer them to higher-level hospitals.

Conclusions: A short training program can improve the ability to identify stroke patients and choose a suitable receiving hospital. A future training program could put further emphasis on how to evaluate comatose patients and choose a suitable receiving hospital.

Keywords: G-FAST; emergency medical service; emergent large vessel occlusion; endovascular thrombectomy; experience; training.

MeSH terms

  • Clinical Competence* / standards
  • Emergency Medical Services / methods*
  • Emergency Medical Services / standards
  • Emergency Medical Technicians / education*
  • Emergency Medical Technicians / standards
  • Female
  • Humans
  • Male
  • Stroke / diagnosis
  • Stroke / surgery*
  • Thrombectomy / education*
  • Thrombectomy / methods*
  • Thrombectomy / standards