Abstract DP108: Confidence in Action: How Confidence Shapes Stroke Screening Tool Utilization Among Texas EMS Providers

Background: Stroke screening tools are essential for timely recognition and triage of patients with suspected stroke in the prehospital setting. Despite widespread adoption, variability remains in which tools EMS providers use, how often they receive training, and their confidence in tool performance. Understanding these factors is critical to guide targeted interventions that can improve early stroke detection and patient outcomes. Methods: We conducted a statewide Texas EMS survey to assess associations among provider confidence, training frequency, tool selection, and utilization of stroke screening tools. Confidence was reported as very confident, confident, somewhat confident, or not confident. Utilization frequency was categorized as <25%, 25–50%, 50–75%, >75%, or never. Training frequency was classified as never, one-time, every 2–5 years, or annually. Associations were analyzed using chi-square tests with Cramér’s V to estimate effect size. Results: Confidence was the most important predictor of utilization frequency. Among providers using a stroke screening tool more than 75% of the time, 66% were very confident and 34% confident, while only 28% of those using a tool <25% of the time reported being very confident (χ 2 =31.6, p=0.0001, Cramér’s V=0.29). Training frequency was significantly associated with confidence (χ 2 =32.1, p=0.0004, Cramér’s V=0.28). Providers trained annually or more often were far more likely to report being very confident compared with those trained less frequently. In contrast, the relationship between training and utilization was weak and not statistically significant (χ 2 =22.3, p=0.33, V=0.06). Tool choice also played a role: use of the Cincinnati tool correlated with higher utilization (χ 2 =23.9, p<0.001, V=0.37), whereas FAST and LAMS did not independently predict utilization. Conclusion: Confidence is the strongest determinant of EMS stroke screening tool use. Training is key driver of confidence, with annual or more frequent training associated with the highest confidence levels. Tool choice has a smaller role, with Cincinnati users reporting higher utilization, likely reflecting familiarity and system preference. These findings highlight the importance of structured, recurring education to strengthen confidence and reinforce consistent stroke screening in the field. Strengthening confidence through education may represent the most impactful pathway to improving prehospital stroke recognition and ensuring timely patient care.