Volunteering is at the core of being human. It is, in the words of Martin Luther King Jr, a vote for the kind of community you want to live in. In Italy, it is a vote cast every single day by the thousands of volunteers who keep the wheels of the country’s emergency services turning.
In four provinces of the Piemonte region at the foot of the Alps, almost 1,000 (and counting) of these volunteers have now devoted a total of 1,500 extra hours to caring for their community by each spending an additional 90 minutes learning about stroke.
EMS systems in Italy have regional autonomy, which means the response model differs from region to region. In Piemonte, where this story plays out, an emergency will activate one of three types of emergency medical vehicles (EMVs) – a rescue helicopter, an advanced EMV carrying doctors and/or nurses supported by volunteer rescuers, or a basic EMV carrying a rescue team of volunteers with basic life support skills. In this region, according to a 2020 analysis of EMS in Italy, more than two-thirds of all dispatches employ basic EMVs, which means that around 70 percent of emergencies including stroke are attended by volunteers.
To Dr Matteo Rovera of 118 Novara, the award-winning outfit that coordinates emergency resources in Novara and three neighbouring provinces, it makes sense to invest in the training of volunteers. After conducting a survey of prehospital care in his region last year, he made stroke training for volunteers a priority, and set himself the task of creating an online education course dedicated to stroke basics and local protocols.
The course, which consists of three video lessons and a final test, is available to rescue volunteers from the provinces of Novara, Biella, Vercelli and Verbano Cusio Ossola. Passing the test earns participants a certificate, but making more than one mistake sends you back to the virtual classroom.
The certificate is valuable both as an incentive and for recruiting learners, Dr Rovera says. Successful participants who share their certificates on social media spread the word, encouraging people to sign up in numbers that far exceed expectations. The course was launched on 24 March and by late June Dr Rovera had already issued around 980 certificates. On average this meant that more than 10 volunteers per day were returning to the field equipped with life-saving knowledge about stroke and prehospital stroke protocol.
From his vantage point as dispatch centre physician at 118 Novara, Dr Rovera is seeing the fruits of his labour. Volunteers who have completed the course are focused and enthusiastic when dealing with stroke patients. They’re better at recognising the symptoms, more accurate when using the Cincinnatti Stroke Scale to assess stroke probability, and, most importantly, they’re getting patients to hospital faster. In fact, Dr Rovera says, mere minutes separate the times-to-hospital achieved by volunteers from those recorded for ambulances staffed with doctors and nurses.
As if to prove the adage that knowledge begets learning, volunteers who have completed the stroke course have signalled their interest in knowing more about other emergencies including cardiac arrest. And there is another way in which Dr Rovera’s intervention is expanding its reach: Angels consultants in Italy are enthusiastic about replicating the concept in other regions, with the content adapted to local protocols.
A certified ASLS trainer as well as a member of the EMS Angels steering committee, Dr Rovera also conducts in-person stroke workshops for physicians and nurses. This commitment to continuous training and quality improvement is a key reason why, having won a platinum EMS Angels Award in 2022, the 118 Novara will be in Barcelona this September to collect their first diamond award.
