A stroke happens when blood flow to part of the brain is blocked by a clot or a bleed, and brain cells die quickly without treatment. EMS shortens the time to clot-dissolving drugs or clot removal by spotting the signs, setting the last known well time and taking the patient to the right stroke center.
Key symptoms
- Sudden weakness or numbness of the face, arm or leg on one side
- Trouble speaking or understanding
- Sudden loss of vision or double vision
- Loss of balance or coordination
- Sudden severe headache in a brain bleed
What you find on exam
- BE-FAST check: balance, eyes, face, arm, speech, time
- Last known well time from a witness
- Large vessel occlusion scale such as RACE or LAMS
- Glasgow Coma Scale and airway protection
- Blood pressure and heart rhythm
Tests
- Blood glucose to rule out low sugar
- 12-lead ECG
- Hospital: CT head and CT angiography right away
- Blood count, coagulation tests and kidney function
Treatment basics
- Stroke alert to the hospital and rapid transport
- Signs of a severe stroke may go directly to a thrombectomy center per local protocol
- Oxygen only if saturation is below 94 percent; raise the head 30 degrees if vomiting
- Nothing by mouth; correct glucose below 60 mg/dL
- Hospital: thrombolysis with alteplase or tenecteplase, and thrombectomy for selected patients
Red flags
- Symptoms that started within the last 24 hours (treatment window)
- Falling level of consciousness or vomiting
- Taking anticoagulants
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.