About
Section 1: General Patient Care
Section 2: Medical Protocols
2.01 - Adrenal Insufficiency / Crisis (Adult & Pediatric)2.02A - Allergic Reaction / Anaphylaxis2.02P - Allergic Reaction / Anaphylaxis2.03A - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Adult2.03P - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Pediatric2.04 - Behaviorial Emergencies (Adult & Pediatric)2.05 - Behaviorial Emergencies - Restraints (Adult & Pediatric)2.06A - Bronchospasm / Respiratory Distress (Adult)2.06P - Bronchospasm / Respiratory Distress (Pediatric)2.07 - Hyperthermia (Environmental - Adult & Pediatric)2.08 - Hypothermia (Environmental - Adult & Pediatric)2.09 - Nerve Agent / Organophosphate Poisoning2.10 - Obstetrical Emergencies2.11 - Newly Born Care2.12 - Resuscitation of the Newly born2.13 - Pain and Nausea Management2.14 - Poisoning / Substance Abuse / Overdose2.15A - Seizures2.15P - Seizures2.16A - Shock2.16P - Shock2.17A - Sepsis2.17P - Sepsis2.18 - Stroke2.19 - Hyperkalemia2.20 - Home Hemodialysis Emergency Disconnect
Section 3: Cardiac Emergencies
Section 4: Trauma Protocols
Section 5: Airway Protocols & Procedures
Section 6: Medical Director Options
Section 7: Medical Policies & Procedures
Section 8: Special Operations Principles
Appendices
2.18 - Stroke
Caution:
Say “Stroke Alert” in Hospital Entry Note if patient meets the Stroke Criteria, even if symptoms have resolved.
EMT-Basic (Standing Orders)
EMT-Advanced (Standing Orders)
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.
Caution:
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.
Note:
This checklist is included as a resource for EMTs and receiving hospitals. If used, please leave a copy with the patient and document all elements on Patient Care Report
Date:
Amb #:
Age:
Gender:
Patient's Name:
Date Of Birth:
STROKE ALERT! Criteria:
Yes
No
Unknown
Time last known well (TLKW) <5hours?
Any abnormal finding not attributable to head trauma?
Blood Glucose >60?
Time Last Known Well:
Blood Glucose Level:
mg/dL
Fast ED Stroke Scale
Item
Score
Facial Palsy
Normal or minor paralysis
0
Partial or complete paralysis
1
Arm weakness
No drift
0
Drift or some effort against gravity
1
No effort against gravity or no movement
2
Speech changes
Absent
0
Mild to moderate
1
Severe, global aphasia, or mute
2
Eye Deviation
Absent
0
Partial
1
Forced Deviation
2
Denial / Neglect
Absent
0
Extinction to bilateral simultaneous stimulation in only 1 sensory modality
1
Does not recognize own hand or orients only to one side of the body
2
Medications
Coumadin / Warfarin
Pradaxa / Dabigatran
Xaralto / Rivaroxaban
Eliquis / Apixaban
Aspirin
Conditions
Head Trauma / Seizures
Cardiac Arrhythmias
Recent / current bleeding, trauma, surgery or invasive procedure
Bleeding disorder
Pregnancy