Prehospital Stroke Assessment through NIHSS Certification of 600 Paramedics

Introduction: Accurate prehospital stroke identification is critical to ensuring timely treatment and improving patient outcomes. The National Institutes of Health Stroke Scale (NIHSS) is an established tool for assessing stroke severity, but it is not commonly used by paramedics. This project aimed to enhance prehospital stroke care by training paramedics to use NIHSS for early stroke assessment. Methods: A full-day training program was developed, where paramedics were educated on all aspects of the NIHSS. The training was performed in groups of 10-20 paramedics per session. Training included sessions covering the step by-step use of the NIHSS, followed by practical exercises. After completing the training, each paramedic took an online certification exam on the BlueCloud platform. BlueCloud is an online platform that provides certification and training programs, including NIH Stroke Scale (NIHSS) certification. The certification was for the course ‘AA01.1 - NIHSS-English Group A-V5 - 1st Certification.’ Training started in May 2024, when the first groups of paramedics were certified. Results: A total of 600 paramedics were enrolled in the training program. By the end of 2024, approximately half of the paramedics had been certified, and the remaining paramedics are scheduled to be trained and certified in NIHSS by spring 2025. Three paramedics did not pass certification on the first attempt; two passed on the second, while one abstained from a second attempt. Conclusion: Certifying paramedics in NIHSS through a structured training and examination program is a feasible approach to improving prehospital stroke assessment. Evaluation is necessary to assess the long-term impact on patient outcomes.