"To know even one life has breathed easier because you have lived. This is to have succeeded."
On this definition of success, attributed to the poet Ralph Waldo Emerson, the Barceló Hotel in Budapest welcomed a large party of successful people early on Monday 19 September.
These men and women had all, and on many occasions, made a difference in someone’s life at the precise moment when that life was in imminent danger. They were all here for the same reason – to give even more lives a second chance.
The paramedics who gathered in Budapest on this rainy autumn morning were from Czech Republic, Romania, Poland, Portugal, Italy, Hungary and Slovakia. They had all completed all nine modules of the Advanced Stroke Life Support (ASLS) course via elearning in the Angels Academy. Now they were in Hungary for a practical training session that would ultimately lead to ASLS certification.
It was a rare opportunity that had been some years in the making.
The ASLS curriculum was developed by experts in stroke, emergency medicine and prehospital care at the Gordon Centre for Research in Medical Education which is based at the University of Miami in Florida, US. It is widely used by hospitals, fire rescue, ambulance and EMS systems around the globe.
In 2019, rights to the online ASLS course developed by David Davis and Paul Meek from the UK were acquired by the Angels Initiative. It became part of the Angels Academy where it has so far been completed by more than 7,600 doctors, nurses and paramedics.
The right to become an ASLS training provider can however only be obtained after hands-on practical training by ASLS certified trainers.
In October 2019 three ASLS trainers from the US and UK flew to Prague where the European Emergency Medicine Congress was taking place. Also in Prague were18 paramedics from six countries across Europe who over the next two days would earn the status of certified ASLS trainer.
In Budapest in 2022 another 30 would follow in their footsteps and this time the trainers from the US and the UK would be joined by three alumni of the 2019 course – Matej Polák from Slovakia, Petr Jaššo from Czech Republic and Nicolas Riera from Spain.
Ivette Motola is associate professor of emergency medicine at the University of Miami School of Medicine and passionate about leveraging education and technology to help healthcare professionals deliver the highest quality evidence-based care to patients across the world. Her colleague Al Brotons is director of training operations at the Gordons Centre and a former battalion chief for fire rescue. Together with David Davis they would lead the two-day workshop in Budapest, running through the theory on day one, and getting down to business on day two.
For the practical session, participants were divided into six smaller groups and, moving from station to station, received hands-on instruction in diagnosing stroke, recognising different subtypes of stroke, and detecting stroke severity by performing the Miami Emergency Neurologic Deficit (MEND) exam.
The ability to assess stroke severity enables paramedics to determine whether a patient is a thrombectomy candidate and should be transported to a comprehensive centre, says Angels team leader Robert Havalda, who was present in both Prague and Budapest.
Angels consultants in the respective countries will now help the newly certified ASLS trainers set up registered ASLS centres where even more paramedics can receive specialist training in stroke care. The sense of achievement that comes from making broad impact on prehospital stroke care in their countries is voiced by Matej Polák, CEO of Slovakia’s most innovative emergency medical service.
“I feel a sense of pride that my team and I were among the first to complete this course in Europe,” Matej says. “When we started there were just a handful of countries. Seeing more and more countries joining the ASLS training is a clear sign that prehospital care in Europe is improving at a fast pace.
"But more importantly I feel great hope when I think of how many quality life years can be saved for our patients as the result of high-quality care provided by educated and trained EMS professionals. ASLS training brings us closer to this goal."
The impact on practice is immediately discernible, says Robert, who reports that a patient has already been saved because the ASLS-trained paramedic was able to diagnose a subtype of stroke that would otherwise have gone undetected. “We’ve also heard from physicians who say that receiving more accurate information during prenotification calls means they can be better prepared for a patient’s arrival.”
Although the aims were certainly serious, the atmosphere in Budapest was not, the pratical sessions frequently erupting in raucous laughter. Bonds were created across borders and even those from the same country who’d arrived as individuals left as teams.
“Paramedics are the best people,” Robert says. “They really love what they do. They never complain, they get straight to the point, they have fun.”
Which brings to mind something else the poet Emerson said about success: To laugh often and much – this, too, is to have succeeded.