‘Advanced Stroke Life Support’ Course Uses Sim to Train Tens of Thousands of Providers

A study presented at the International Stroke Conference (ISC) in January by the University of Miami Michael S. Gordon Center for Research in Medical Education (GCRME) documents its simulation-based Advanced Stroke Life Support (ASLS) curriculum significantly improves prehospital and hospital-based providers’ knowledge of stroke diagnosis and management and effectively leads to improved detection and timely management of these patients.

As healthcare providers, we can all imagine the fear of not being able to put our thoughts into words or struggling to move our limbs. The administration of tPA (clot-dissolving tissue plasminogen activator) and advent of intravascular interventions can reduce the occurrence of such disabilities, but crucial to a successful outcome is early recognition and treatment. A course specific to this training in a simulated environment provides a powerful way to identify the subtle warning signs to stroke.

The 8-hour, evidence-based ASLS course from GCRME was first developed in 1998 and has expanded dramatically to be offered now to more than 120 registered training centers across the United States. About 70% of the courses offerings are located at hospitals, followed by EMS agencies or other healthcare educational institutions. Tens of thousands of healthcare professionals have completed an ASLS course, which consists of 3.5 hours of didactic lectures and 4.5 hours of interactive large and small-group skills sessions.


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The content and structure of GCRME’s ASLS course is uniquely and ideally designed for all healthcare providers who care for stroke patients through the continuum of care, including prehospital providers on-scene, nurses and physicians in the emergency department, and inpatient providers in the stroke or critical care unit. Concurrent 90-minute breakout sessions facilitate content specific to participants’ professional roles.

Interactive sessions include video-based cases, where learners diagnose and develop a management plan for patients with stroke or stroke mimics. In the skills sessions, learners conduct a neurological exam on simulated patients portraying major stroke symptoms. Participants determine a diagnosis and management plan using a standardized patient evaluation tool, one of which is the MEND — Miami Emergency Neurologic Deficit—exam, a brief and practical stroke assessment developed as part of the ASLS curriculum, that was recently validated as an effective screening tool for detecting stroke by another study presented at the 2018 ISC. The MEND exam contains the Cincinnati Prehospital Stroke Scale and additional components from the National Institutes of Health Stroke Scale to detect both anterior and posterior circulation strokes.

Studies of ASLS and the MEND exam show the educational and clinical value of their effectiveness, and feedback from users in the field reveal the even more important  beneficial human impact. One such success story comes from a North Carolina paramedic who completed the ASLS training.

Upon arriving to a call and performing an initial assessment, the team believed the patient may only have a gastrointestinal illness. However, when moved to the rescue truck the ASLS-trained paramedic performed the MEND exam and found the patient’s right eye was unable to follow the paramedic’s finger and responded in slurred speech. The first responders made the decision to call a “Code Stroke” and quickly transported the patient to the hospital, where the medical team confirmed the diagnosis and saved the patient’s life. The paramedic suggested that what she learned in the ASLS course helped to find the bleed in time.


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ASLS Course Learning Goals

A key feature of the ASLS curriculum is hands-on skills training, during which instructors simulate stroke syndromes, and learners perform the MEND Examination, a unique neurologic assessment tool developed with the course. Computer-based multimedia skills training, interactive discussions, and didactic sessions are also components of the curriculum. The major learning goals for course participants are to:

  • Describe why early treatment may result in a marked reduction in risk of disability
  • Identify the five main stroke syndromes and relate them to pathophysiology and clinical signs
  • Perform focused evaluation to identify stroke, its location and severity, and t-PA contraindications.

Learn more about GCRME’s Advanced Stroke Life Support research, training, and local implementation!


Today’s article was guest authored by Jill A Hershbein, Executive Director, Programs at University of Miami Gordon Center for Research in Medical Education.

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