Stroke Scales
The Cincinnati Prehospital Stroke Scale checks facial droop, arm drift, and abnormal speech. Any one abnormal finding suggests a stroke with high probability. The BE-FAST version adds balance and eyes to improve detection of posterior strokes.
Time Is Brain
Establish the time the patient was last known to be normal, not simply when symptoms were noticed. Fibrinolytic therapy is time-limited, so this information drives treatment eligibility. Check blood glucose, since hypoglycemia can mimic stroke.
Destination and Care
Transport to a stroke-capable center, and notify the hospital early. Keep the patient NPO, maintain airway and oxygenation, and avoid lowering blood pressure unless directed. Large vessel occlusion screening tools may direct patients to comprehensive stroke centers.