5
Prehospital Stroke Management
Table 4. Stroke Chain of Survival
Detection Patient or bystander recognition of stroke signs and symptoms
Dispatch Immediate activation of 9-1-1 and priority EMS dispatch
Delivery Prompt triage and transport to most appropriate stroke hospital
and prehospital notification
Door Immediate ED triage to high-acuity area
Data Prompt ED evaluation, stroke team activation, laboratory
studies, and brain imaging
Decision Diagnosis and determination of most appropriate therapy.
Discussion with patient and family
Drug Administration of appropriate drugs or other interventions
Disposition Timely admission to stroke unit, intensive care unit, or transfer
Table 5. Prehospital Evaluation and Management
of Potential Stroke Patients
Recommended NOT Recommended
Assess and manage ABCs Do NOT initiate interventions for
hypertension unless directed by medical
command
Initiate cardiac monitoring
Provide supplemental oxygen to maintain
O
2
saturation >94%
Establish IV access per local protocol Do NOT administer excessive IV fluids
Determine blood glucose and treat
accordingly
Do NOT administer dextrose-containing
fluids in nonhypoglycemic patients
Do NOT administer medications by
mouth (maintain NPO)
Determine time of symptom onset or last
known normal, and obtain family contact
information, preferably a cell phone
Triage and rapidly transport patient to
nearest most appropriate stroke hospital
Do NOT delay transport for prehospital
interventions
Notify hospital of pending stroke patient
arrival
