Background: Endovascular thrombectomy has been proven to benefit patients with large vessel occlusion (LVO). The sooner the endovascular treatment is given, the better the functional outcome. Therefore, resuscitation guidelines recommended the strategy of bypassing the patients with LVO to the hospitals with endovascular capabilities if they could be identified in the prehospital setting. However, in the past, there was no training course for emergency medical technicians (EMTs) to identify patients with LVO in Taiwan. 

Objective: We aimed to evaluate the effect of the training course on EMTs for identifying patients with LVO by G-FAST score (i.e. Gaze, Face, Arm, Speech, and Time). The effect was measured by the changes in knowledge, attitude, confidence, and simulation performance of trainees.

Method: EMTs in Taipei City were enrolled in the G-FAST training course from May 15th to November 15th, 2017. The course included a 30-minute lecture and a 20-minute video demonstration of performing G-FAST. The trainees received exams with the same questions before and after the course. The exams included two parts: (1) the questionnaire regarding knowledge (full score, 10), attitude and confidence (using 5-point Likert scales) of providing care to patients with stroke, and (2) simulation tests by watching ten videos and answering the questions about scenario judgment, including the parameters of G-FAST and the decision of destination hospital. 

Result: Totally 1058 EMTs were enrolled, and 96.1% of them were EMT-2. Significant improvement was found in knowledge (8.80 vs 9.36, p<0.001), attitude (all items, p<0.001), confidence (all items, p<0.001) of providing care to patients with stroke, and choosing the appropriate destination hospitals (5.48 vs 7.83, p<0.001) in simulation test after training. Among participants who chose the inappropriate hospitals, we found they tended to transport patients to hospitals of higher level despite they correctly judged the G-FAST parameters. 

Conclusion: The G-FAST training course significantly improved the knowledge, attitude, and confidence and simulation performance of EMTs in identifying patients with LVO in Taiwan. EMTs tended to transport patients to higher-level hospitals than their judgment. Further study is needed to validate the clinical performance of EMTs after the G-FAST training course.

3 - The effect of G-FAST (Gaze, Face, Arm, Speech, and Time) training on emergency medical technicians for identifying patients with large vessel occlusion in Taipei.