7
2.3. Prehospital Assessment and Management
COR LOE
Recommendations
Dispatch
2a B-NR
1. In callers to 9-1-1, EMS dispatch use of a telephone stroke
assessment tool is reasonable and can be beneficial in early
identification of stroke, reduced on-scene time, and/or
prioritization of transport.
Ambulance transport
1 A
2. In patients with suspected stroke transported by ambulance,
use of a brief stroke assessment tool by prehospital personnel
is recommended to improve early stroke identification,
including large vessel occlusion (LVO) stroke.
1 B-NR
3. In patients with suspected stroke transported by ambulance,
prehospital personnel should provide advance notification
to the receiving hospital of an inbound suspected stroke to
reduce in-hospital evaluation times, increase thrombolytic
use, and decrease mortality.
3: No
benefit
B-R
4. In patients with suspected stroke transported by ambulance,
ambulance-initiated remote ischemic conditioning (RIC)
with arm blood pressure (BP) cuff inflation does not improve
functional outcome and is not recommended.
3: Harm A
5. In patients with suspected stroke transported by ambulance,
prehospital initiation of stroke treatment with transdermal
glyceryl trinitrate (GTN, nitroglycerin) does not improve
functional outcome and is potentially harmful.
3: No
benefit
B-R
6. In patients with suspected stroke transported by ambulance,
intensive BP control in the field to a target of 130 to140 mm
Hg systolic does not improve functional outcome.
2b B-NR
7. (New and of High Impact) In pediatric patients with
suspected stroke transported by ambulance, the usefulness
of common adult stroke screening tools is uncertain
because they perform poorly for identification of stroke.
Newer pediatric stroke screening tools demonstrate good
interrater reliability; however, their sensitivity, specificity,
and predictive value in the prehospital setting remain to be
determined, and their usefulness is unknown.
