100% of respondents including: ensure all ambulance services maintain readiness for MCIs; conduct joint training and exercise programs; adopt a common model for managing MCIs; and recognize the authority of only one on-site EMS commander. One policy that was proposed was that the senior EMS officer arriving on-site should not necessarily take over command and was endorsed by 92% in the 2 nd e-Delphi cycle. Variability among experts according to origin country was noted concerning: (1) assign ambulances to off-duty EMS staff; and (2) dispatch two BLS and two ALS ambulances as an automatic MCI response. Conclusion: Clear policies shared by all EMSs are needed to ensure effective management and maximal life-saving capacity in MCIs. The study presents consensus-based solutions to varied challenges common to EMS worldwide. Additional studies are needed to further develop policies into measurable and comparable international standards. Prehosp Disaster Med 2017;32(Suppl. 1):s93-s94 doi:10.1017/S1049023X17002412 Evaluation of the Situation of Trainings Provided by Çanakkale 112 Ambulance Services Hüseyin Koçak 1 , Cüneyt Çalışkan 2 , Bektaş Sari 3 , Ismail Köse 4 , Ibrahim Tuncay 5 1. Disaster Medicine Doctorate Student, Bezmialem Vakıf Univesity Institute of Health, İstanbul/Turkey 2. Emergency Aid And Disaster Management, Çanakkale Onsekiz Mart University, Çanakkale/Turkey 3. State Hospital, Ministry of Health, Çanakkale/Turkey 4. Director Of Education Unit, Çanakkale Provincial Health Directorate, 112 Ambulance Service Chief Physician, Çanakkale/ Turkey 5. Orthopedics And Traumatology Department, Bezmialem Vakif University. Faculty of Medicine, İstanbul/Turkey Study/Objective: The purpose of this study is to evaluate the present situation as of November 1, 2016, in regard to in-service training provided by the Training Unit of Çanakkale 112 Emergency Medical Services (ÇEMS). Background: It is important to constantly update and improve personnel training in Emergency Medical Services. The following trainings are provided to personnel in pre-hospital health services: Basic Module Training (BMT), Trauma and Resuscitation Training (TRT), Advanced Life Support Training (ALST), Child Advanced Life Support Training (CALST) and Training for Ambulance Driving Techniques (TADT). Methods: The study is a descriptive epidemiological study. The data was obtained from the records by Training Unit of Chief of Staff of Çanakkale 112 Ambulance Service. Results: A total of 395 personnel are employed in ÇEMS. Of those, 57,5% (n = 227) are Emergency Medical Technicians (EMTs); 20,0% (n = 79) are Emergency Medical Technicians (Paramedics). In all, 89,8% of all of the personnel (n = 307) received the BMT; 90,1% (n = 308) received the TRT; 71,6% (n = 245) received the CALST; 61,1% (n = 209) received the ALST. Only 37,0% of them received the TATD. 97% of EMTs (n = 220) received the BMT; 99,0% of them (n = 224) received the TRT; 78,0% of them (n = 177) received the CALST; 70,0% (n = 160) received the ALST; 32,0% (n = 72) received the TATD. Further, 86.0% of paramedics (n = 68) received the BMT; 87.0% of them (n = 69) received the TRT; 67,0% of them (n = 53) received the CALST; 53,0% (n = 42) received the ALST; and, 23,0% (n = 18) received the TATD. 25,0% of doctors received the BMT; 12,0% of them (n = 2) received the TRT; 38,0% (n = 6) received the CALST and 12,0% (n = 2) received the ALST. Conclusion: It was concluded that since the BMT and TRT were performed in the city of Çanakkale, the participation of EMS personnel was high; on the other hand, since the ALST and CALST were performed in the city of Bursa, the partici- pation percentage of EMS personnel was lower. Prehosp Disaster Med 2017;32(Suppl. 1):s94 doi:10.1017/S1049023X17002424 Changes in Quality of Prehospital Care and Time Delays in Acute Stroke in Tallinn, Estonia from 2005 to 2016 Katrin Gross-Paju 1 , Kateriine Orav 1 , Raul Adlas 2 , Ulvi Thomson 3 , Helle Jaakmees 4 , Karin Kannel 4 , Svetlana Mironenko 4 , Agnes Reitsnik 4 , Valli Kaljula 4 , Ain Vares 4 , Sandra Ütt 4 1. Tallinn University of Technology, Tallinn/Estonia 2. Tallinn Emergency services, Tallinn/Estonia 3. Stroke Centre, West.Tallinn Central Hospital, Tallinn/Estonia 4. West.Tallinn Central Hospital, Tallinn/Estonia Study/Objective: The aim of the study was to analyze changes in quality and time delays in prehospital stroke management, and their influence on Door-to-Needle Time (DNT). Background: Interval between stroke onset and thrombolysis determine the efficacy. Guidelines for stroke management were introduced in 2008 in Tallinn Emergency Medical Services (TEMS). Since 2014, the requirement of pre-arrival information by phone call of a possible thrombolysis patient to the West Tallinn Central Hospital (WTCH)-SS neurologist is in the TEMS guidelines. Since 2014, thrombolysis starts on Computed Tomography table (CT) at WTCH-SS. Methods: Data of all consecutive thrombolysed stroke patients were recorded prospectively since January 1, 2005 to November 1, 2016 at WTCH-SS. Ambulance records of thrombolysed and non-thrombolysed stroke patients managed by TEMS were retrospectively analysed since 2009. Analysis was conducted for three periods: 2005-2009, 2009- 2011, and 1/1-1/11/2016. Results: TEMS records were analyzed for 3666 stroke, including 243 thrombosed, patients during selected periods. Changes are depicted in the table. The exact time of onset was recorded on 38.9% (2009-20011) and on 62.4% (2016) of TEMS records. TEMS response time with ECG performed or ECG monitoring was 26.8 and 24.8 minutes, respectively versus 18.2 minutes without ECG. The pre-arrival information of possible thrombolysis to WTCH-SS was recorded in 28.7%. With pre-arrival information mean DNT was 25.8 versus 50.3 minutes without prior call. Conclusion: TEMS adherence to guidelines has improved, but ECG is performed. DNT times have improved at WTCH- SS. The factors for improved DNT were related to pre-arrival information of possible thrombolysis patients by TEMS and start of thrombolysis in CT. Prehospital and Disaster Medicine Vol. 32, Supplement 1 s94 Improving Emergency Medical Team Capacity https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1049023X17002436 Downloaded from https://www.cambridge.org/core. IP address: 168.151.122.43, on 29 Sep 2017 at 10:10:41, subject to the Cambridge Core terms of use, available at