Prehospital neurological emergencies– a survey on the state of prehospital neurological assessment by emergency medical professionals
Abstract Background Neurological emergencies are one of the major diagnosis groups in the Emergency Medical Services (EMS) with the highest rate of misdiagnosis. Despite the knowledge of time sensitivity and the importance of prehospital factors, prehospital delay is common. Although several stroke...
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BMC
2024-09-01
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| Series: | BMC Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12873-024-01076-w |
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| author | Vesta Brauckmann Dominica Hudasch Pascal Gräff Torben Riecke Gökmen Aktas Jorge Mayor Christian Macke |
| author_facet | Vesta Brauckmann Dominica Hudasch Pascal Gräff Torben Riecke Gökmen Aktas Jorge Mayor Christian Macke |
| author_sort | Vesta Brauckmann |
| collection | DOAJ |
| description | Abstract Background Neurological emergencies are one of the major diagnosis groups in the Emergency Medical Services (EMS) with the highest rate of misdiagnosis. Despite the knowledge of time sensitivity and the importance of prehospital factors, prehospital delay is common. Although several stroke triage scales have been developed, a gold standard in the prehospital setting is lacking. Objectives Our aim was to evaluate the perception of neurological emergencies by EMS personnel and to identify current problems, difficulties and opportunities for improvement in the prehospital management of stroke, seizure, non-specific neurological symptoms, and paediatric neurological emergencies. Methods The study was conducted as an online survey through SoSci Survey and was made available from March 1st to June 30th 2023 to all personnel working in emergency medical services. The access link was distributed through snowballing, social media, and through a QR code on a promotional poster. The survey was completed anonymously. The final survey consisted of 30 questions in German on the topics of neurological emergencies, general neurological assessment, specific neurological examination including paediatric assessment, stroke, and seizures, and finally suggestions for improvement. Results The largest group of participants were paramedics, who estimated to encounter neurological emergencies at a general rate of 20–60%. When unease was felt, the main reasons were ambiguity of symptoms and insufficient admission capacity of hospitals. The biggest challenges were highly varied. Almost 80% of participants assumed that the neurological assessment would be omitted in difficult patient groups such as demented, intoxicated or children. 75% felt uncomfortable making a paediatric assessment, 50% were unfamiliar with the Paediatric Glasgow Coma Scale. Conclusions Support through more standardized practical training and defined, uniform guidelines is needed. There was also a clear need for peer collaboration, feedback and case sharing. Digitalization, the usage of telemedicine and updated versions of the documentation protocols including paediatric adaptations to current guidelines could further improve current neurological assessment in the prehospital setting. |
| format | Article |
| id | doaj-art-183ce4830218497a950b01c31365e24e |
| institution | OA Journals |
| issn | 1471-227X |
| language | English |
| publishDate | 2024-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj-art-183ce4830218497a950b01c31365e24e2025-08-20T02:22:28ZengBMCBMC Emergency Medicine1471-227X2024-09-012411910.1186/s12873-024-01076-wPrehospital neurological emergencies– a survey on the state of prehospital neurological assessment by emergency medical professionalsVesta Brauckmann0Dominica Hudasch1Pascal Gräff2Torben Riecke3Gökmen Aktas4Jorge Mayor5Christian Macke6Department of Trauma Surgery, Hannover Medical SchoolDepartment of Neurology, Hannover Medical SchoolDepartment of Trauma Surgery, Hannover Medical SchoolDepartment of Trauma Surgery, Hannover Medical SchoolDepartment of Trauma Surgery, Hannover Medical SchoolDepartment of Trauma Surgery, Hannover Medical SchoolDepartment of Trauma Surgery, Hannover Medical SchoolAbstract Background Neurological emergencies are one of the major diagnosis groups in the Emergency Medical Services (EMS) with the highest rate of misdiagnosis. Despite the knowledge of time sensitivity and the importance of prehospital factors, prehospital delay is common. Although several stroke triage scales have been developed, a gold standard in the prehospital setting is lacking. Objectives Our aim was to evaluate the perception of neurological emergencies by EMS personnel and to identify current problems, difficulties and opportunities for improvement in the prehospital management of stroke, seizure, non-specific neurological symptoms, and paediatric neurological emergencies. Methods The study was conducted as an online survey through SoSci Survey and was made available from March 1st to June 30th 2023 to all personnel working in emergency medical services. The access link was distributed through snowballing, social media, and through a QR code on a promotional poster. The survey was completed anonymously. The final survey consisted of 30 questions in German on the topics of neurological emergencies, general neurological assessment, specific neurological examination including paediatric assessment, stroke, and seizures, and finally suggestions for improvement. Results The largest group of participants were paramedics, who estimated to encounter neurological emergencies at a general rate of 20–60%. When unease was felt, the main reasons were ambiguity of symptoms and insufficient admission capacity of hospitals. The biggest challenges were highly varied. Almost 80% of participants assumed that the neurological assessment would be omitted in difficult patient groups such as demented, intoxicated or children. 75% felt uncomfortable making a paediatric assessment, 50% were unfamiliar with the Paediatric Glasgow Coma Scale. Conclusions Support through more standardized practical training and defined, uniform guidelines is needed. There was also a clear need for peer collaboration, feedback and case sharing. Digitalization, the usage of telemedicine and updated versions of the documentation protocols including paediatric adaptations to current guidelines could further improve current neurological assessment in the prehospital setting.https://doi.org/10.1186/s12873-024-01076-wPrehospital emergency medicineNeurological examinationEMSStrokeEmergency medicine |
| spellingShingle | Vesta Brauckmann Dominica Hudasch Pascal Gräff Torben Riecke Gökmen Aktas Jorge Mayor Christian Macke Prehospital neurological emergencies– a survey on the state of prehospital neurological assessment by emergency medical professionals BMC Emergency Medicine Prehospital emergency medicine Neurological examination EMS Stroke Emergency medicine |
| title | Prehospital neurological emergencies– a survey on the state of prehospital neurological assessment by emergency medical professionals |
| title_full | Prehospital neurological emergencies– a survey on the state of prehospital neurological assessment by emergency medical professionals |
| title_fullStr | Prehospital neurological emergencies– a survey on the state of prehospital neurological assessment by emergency medical professionals |
| title_full_unstemmed | Prehospital neurological emergencies– a survey on the state of prehospital neurological assessment by emergency medical professionals |
| title_short | Prehospital neurological emergencies– a survey on the state of prehospital neurological assessment by emergency medical professionals |
| title_sort | prehospital neurological emergencies a survey on the state of prehospital neurological assessment by emergency medical professionals |
| topic | Prehospital emergency medicine Neurological examination EMS Stroke Emergency medicine |
| url | https://doi.org/10.1186/s12873-024-01076-w |
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