The New Jersey Comprehensive Stroke Center at University Hospital
The Role of EMS
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 be sent.
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.
Clues From Observing the Patient
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 Screen (LAPSS).
Cincinnati 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
- Normal – both sides of face move equally well
- Abnormal – 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
- Normal – both arms move the same or both arms do not move at all
- Abnormal – 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
- Normal – patient uses correct words with no slurring
- Abnormal – 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.
Rapid transport to “Comprehensive Stroke Center
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 overall outcome.
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.