When a call for assistance is placed to 911, emergency
medical responders will be dispatched to the scene. If
stroke is suspected, advanced life support (ALS) will
The ALS team includes paramedics, the highest level
of emergency medical provider with additional advanced
training to provide the most extensive pre-hospital
care. For example, they are permitted to administer
drugs orally and intravenously, interpret electrocardiograms
(EKGs), perform endotracheal intubations, and use monitors
and other complex equipment. They can even carry out
certain emergency treatments for complicated problems
under the direction of medical doctors by radio, preceding
or during transport.
While the emergency response team is preparing to transport
the patient to an appropriate hospital, they will evaluate
clues as to what is causing the problems. This usually
begins with observing the patient and surrounding environment
and questioning family/witnesses.
At times, the general impression of the patient may
clearly suggest a stroke. Signs and symptoms include:
- altered mental status
- impaired speech (aphasia or dysarthria)
- uncoordinated movement/gait disturbance
- severe headache
- one-sided weakness (hemiparesis)
- one-sided paralysis (hemiplegia)
- high blood pressure (hypertension)
- vision disturbances
- unevenly dilated pupils
Physical examination of the patient further assists
in confirming stroke. It also can give clues to the
type of stroke the patient is experiencing.
An examination usually consists of vital-sign readings
– such as blood pressure and pulse. If the patient
is alert, the examination will also include an assessment
of his or her ability to perform certain basic functions.
A “prehospital stroke scale” test is a
common method for quickly assessing a patient’s
responses in key functional areas. The Cincinnati Prehospital
Stroke Scale is the most widely used by emergency response
teams. There is also a Los Angeles Prehospital Stroke
Prehospital Stroke Scale
This test is used to assess a patient’s facial
muscles, arm movement and speech function. Abnormality
in any one strongly suggests stroke.
- The patient is asked to show teeth or smile
– both sides of face move equally well
– one side of face does not move as well
as the other side
- The patient is asked to close both eyes and hold
both arms straight out for 10 seconds
– both arms move the same or both arms do
not move at all
– one arm does not move or one arm drifts
- The patient is asked to repeat a simple phrase,
such as “You can’t teach an old dog new
– patient uses correct words with no slurring
– patient slurs words, uses the wrong words
or is unable to speak
Emergency responders will also try to extract as much
of the patient’s medical information as possible
at the scene. The more information that can be relayed
in advance to the hospital, the faster a diagnosis can
be made and an appropriate treatment plan initiated.
The following information is particularly relevant:
- Time of onset of symptoms.
This is very important in determining if patient is
a candidate for some new therapies that are most effective
when used within a certain timeframe.
- Medications the patient
is taking. Certain medications can
thicken the blood so it clots more (a problem in ischemic
strokes), while others have the opposite effect (which
can exacerbate a hemorraghic stroke). For example,
blood thinning medications such as anticoagulants
(e.g., Coumadin® or Lovenox®) or antiplatelets
(e.g., aspirin, Ecotrin®, Plavix® or Ticlid®)
may have indications for use in ischemic strokes,
but they can also result in hemorrhages.
- Patient’s medical
history. In particular, emergency
responders will be looking for a history of the patient
suffering related diseases and risk factors, such
as hypertension, diabetes or heart disease, as well
as prior stroke(s) or transient ischemic attack(s).
A family medical history of stroke or related diseases
is also taken into account.
The pre-hospital emergency response team assesses and
transports possible stroke victims to the hospital without
delay. With today’s technological and pharmacological
advances, early intervention can significantly reduce
the damage from a stroke and improve the patient’s
A patient’s greatest chance for the best outcome
is to be taken to a “comprehensive stroke center”.
This is a hospital that is fully equipped at all levels,
around the clock, to provide the most appropriate treatment
as quickly as possible.