Why Rapid Stroke Assessment Matters
Stroke is a time-sensitive emergency. The window for thrombolytic therapy (clot-busting medication) is limited, and every minute of delay results in approximately 1.9 million neurons lost. Prehospital stroke recognition and rapid transport to a stroke center directly impact patient outcomes. The NREMT expects you to identify stroke, perform a prehospital stroke assessment, and understand the importance of time.
The Cincinnati Prehospital Stroke Scale
The Cincinnati Prehospital Stroke Scale evaluates three findings: facial droop (ask the patient to smile and look for asymmetry), arm drift (ask the patient to close their eyes and hold both arms out for 10 seconds; watch for one arm drifting downward), and speech abnormalities (ask the patient to repeat a simple sentence and listen for slurred or garbled speech). Any one of these findings is abnormal and suggests a possible stroke.
FAST Assessment
FAST is a mnemonic for stroke recognition: Face (ask the patient to smile; look for drooping), Arms (ask the patient to raise both arms; watch for drift), Speech (ask the patient to repeat a phrase; listen for abnormalities), and Time (note the time of symptom onset and transport immediately). The time of onset is one of the most important pieces of information you can provide to the receiving hospital.
Last Known Well Time
Document the last time the patient was known to be at their normal baseline. This is critical for hospital decision-making about thrombolytic therapy. If the patient woke up with symptoms, the last known well time is when they went to sleep, not when they woke up. Ask family members, witnesses, or caregivers to establish the most accurate time possible.
Transport Decisions
Transport stroke patients to a designated stroke center whenever possible, even if it means bypassing a closer hospital. The additional transport time is offset by the specialized care available at a stroke center. Provide a prehospital notification to the receiving facility so they can activate their stroke team before your arrival. The NREMT expects you to understand the value of stroke center transport and prehospital notification.