Abstract WP180: Statewide Survey of Prehospital Stroke Screening Practices Among EMS Providers in Texas

Intro: 2024 GWTG data shows low rates of stroke screening (31%), severity tool performance (18%), and prehospital notification (52%) in Texas. To assess current practices, the Texas Governor’s EMS and Trauma Advisory Council, in collaboration with the Dept of State Health Services (DSHS), conducted a statewide EMS survey. Methods: A REDCap survey was distributed statewide (Oct 2024–Jan 2025) via DSHS email lists for registered EMS providers, assessing practice setting, documentation, stroke screening tool utilization, confidence, training, and pre-notification. Results: Of 189 respondents, 147 (78%) completed and 42 (22%) partially completed the survey. Respondents included paramedics (73%), EMTs (9%), RNs (9%), AEMTs (6%), and EMS medical directors (7%); 71% reported leadership roles. Practice settings were rural (44%), urban (28%),&suburban (28%), spanning 14/22 Trauma Service Areas (29% from TSA-E). Most reported using electronic patient care record (96%). Stroke screening: 152 (98%) reported being instructed to use a tool. The most frequently cited were CPSS (86%) and FAST (43%). Performance confidence was high: very confident (58%), confident (36%), somewhat confident (5%), not confident (2%). Training occurred yearly (40%), more than once yearly (27%), or less often (33%). Stroke screening was reported as performed in >75% of suspected cases by (68%), with smaller proportions reporting less consistent use. LVO screening adoption was less widespread. 104 (68%) were instructed to use an LVO tool. Most common tools included VAN (51%), C-STAT (19%). Confidence was lower than standard screening: very confident (47%), confident (35%), somewhat confident (18%), and not confident (1). Training was annual (43%) or more frequent (25%), but 11 reported only one exposure or no training. In practice, 51% reported LVO tools used in >75% of suspected cases, but 21% used them <25% of the time&2 never. Hospital pre-notification was frequent, with >75% reported by 80%. Documentation was via structured fields (59%) or narrative notes (41%). Leadership and non-leadership respondents reported similar overall tool use and pre-arrival notification rates. Conclusions: Texas EMS providers report utilizing prehospital stroke screening. Confidence is high, and hospital pre-notification is reported as consistently practiced. However, variability in training and documentation persists. LVO tool adoption is moderate, with lower confidence, less frequent training, and less use.