There were a dozen patients on day one alone.
They included a young woman who had dropped a cup of tea after her arm grew numb, a patient with light hemiparesis, another with right hemiplegia and aphasia, and one with a tremor that was discovered to be caused by back pain.
Next, Petr Jaššo, who is the EMS education chief for the Moravian Silesian Region in Ostrava, Czech Republic, revealed a gift for performance by playing, among others, an alcohol-intoxicated patient who would turn out to be a stroke mimic, a patient experiencing epileptic seizures, and a patient from a retirement home whose pre-mRS score suggested a pre-existing disability.
The setting was a Train the Trainer event in Mainz, Germany, and it was something of a milestone. This was the twentieth time the Angels Initiative core team had invited healthcare professionals from across Europe to two days of intensive training in stroke care – a stroke education concept it first put to the test in December 2017 in Wiesbaden, and which has subsequently been replicated around the world.
Train-the-trainer events are a cornerstone of the Angels education programme. They are held at regular intervals in a central location where neurologists attend two days of intensive training. Doctors who have completed the training are encouraged to use Angels slides and learning resources for their own training presentations and workshops in their own hospitals and regions. A key advantage of the format is that it scales training delivery in a cost-effective way while maintaining consistency, but Angels Train the Trainer events have accomplished much more. They have given a platform to bright spots in stroke care from across Europe, and they have grown and strengthened the Angels community, creating an ever expanding cohort of professionals united in the fight against stroke.
Winds of change
The most recent Train the Trainer (TTT) was a little different, say core team leader Rita Rodrigues and project manager Madeline Bucher, who were principally responsible for creating the event. In the past, the agenda was primarily designed for neurologists, but after consultation with country coordinators in the Baltic and Balkans it was decided to extend the event to the emergency medical services. As a result, 20 pairs of attendees from 10 countries were nominated for the event, each pair consisting of a neurologist and EMS professional from the same region. The expectation was that this would positively impact regional performance, as collaboration between hospitals and EMS is a central tenet of the 100 Angels Regions strategy.
This was, however important, far from the only thing that distinguished this event from previous ones.
The 10 countries that sent delegates to Mainz included a newcomer and a comeback. Bosnia & Herzegovina attended for the first time, and Serbia was back after an absence of several years, thanks to Angels consultant Maria Sheverdina’s work in the territory. Also represented were Armenia, Croatia, Estonia, Latvia, Lithuania, North Macedonia, Kazakhstan and Kyrgyzstan.
All participants were set a course in the Angels Academy ahead of the event – “Optimizing the Hyperacute Pathway” for hospital participants, and for EMS, “Advanced Stroke Life Support for Prehospital Providers”. Having completed the ASLS elearning in the Academy, EMS participants could look forward to practical instruction by Petr Jaššo and Slovakia’s Matej Polák and Patrik Brna of multi-award-winning ZaMED. Later on day one Matej and Patrik would moderate and score performances in the inaugural Stroke Simulation Cup for EMS, with Petr bringing some realism to the patient simulations, and the teams from Latvia and Lithuania sharing the spoils.
A plan comes together
There were more patients on day two, which opened with NIHSS training by Dr Elena Terecoasa for Romania, and a session on Quality Monitoring during which consultants Lev Prystipiuk and Maria Sheverdina and team leader Silvia Ripaponti Angels project lead Belén Velázquez to provide practical advice for making data collection part of daily practice, capturing data on RES-Q, and using data analysis to improve performance.
In the afternoon, new Angels consultant Federica di Fonzo from Italy, attending her first TTT, slipped on the red patient vest for the first of two simulations that always conclude the agenda, drawing on the knowledge gained in the course of the event.
Simulations are guided by experts and broadcast to the main plenary room, where this year the addition of a roving camera operator helped the audience follow proceedings in more detail. The main difference however was that these scenarios included the prehospital phase. The action began in the patient’s home where 30-year-old “Patricia” had collapsed in the shower after complaining of a mild headache for several hours. When sudden left-leg weakness sent Patricia/Federica to the bathroom floor, her roommate called 112 for help.
Despite their clear nervousness and stress the simulation teams fared quite well, Madeline reports. The detailed debriefings and discussions that followed served as learning reinforcement for the entire group, improving knowledge retention and ultimately leading to sustained behaviour changes.
As for the changes introduced on the twentieth anniversary of TTTs, despite their own initial nervousness, Rita and Madeline are upbeat about the outcomes.
Bringing hospitals and EMS together in this training format fosters relationships between prehospital and hyper acute teams, they say. It builds networks that lead to enhanced pathways and ultimately saves lives.
