RED FLAG: Say “Stroke Alert” in Hospital Entry Note if patient meets the Stroke Criteria, even if symptoms have resolved.
EMT/ADVANCED EMT/PARAMEDIC STANDING ORDERS
1.0 Routine Patient Care
Perform FAST-ED Stroke Scale.
Clearly determine last time known well.
If the patient wakes from sleep or is found with symptoms of stroke, the time is defined as the last time the patient was observed to be normal. Notify the emergency department as soon as possible.
If any one of the signs of the stroke scale is abnormal and onset of symptoms are less than 5 hours, notify receiving hospital of a “Stroke Alert.”
Elevate the head of the stretcher 30 degrees.
Do not delay transport for ALS intercept.
Consider transporting a witness, family member, or caregiver with the patient to verify the time of the onset of stroke symptoms.
If the onset of signs and symptoms PLUS transport time is <5 hours, consider transport to the most appropriate facility in accordance with local guidelines/agreements.
Transport to a Department approved Stroke Point-of-Entry (POE) hospital.
RED FLAG: Avoid hyperoxygenation; oxygen administration should be titrated to patient condition, and withheld unless evidence of hypoxemia, dyspnea, or an SpO2 <94%, especially in the presence of a suspected CVA/TIA or ACS.