1. Primary Stroke Center EMS Training Union Hospital, Inc. Terre Haute Union Hospital, Inc. Terre Haute

2. Role of EMS in Rapid Response Notification-If patient presents as symptomatic or unstable, announce to medical control via IHERN or other contact method as a “Stroke Alert”. The RRT must be at the bedside within 15 minutes of the alert; the 15 minutes includes the time EMS advises the facility of a stroke alert.

3. Evaluation of Acute Stroke Pertinent patient questions that need to be documented for ED team: – Definite time of onset of signs or symptoms—be precise – Any loss of consciousness or mental status changes –Any neurological deficits: seizures, unilateral weakness, grip, smile – Any slurred speech, blurred vision, or aphasia – Past CVA or TIA – Pertinent medical history: has pt recently fallen or had any head trauma – Current medications with time anti-coagulants last taken

4. Assessment of Acute Stroke The Cincinnati Pre-hospital Stroke Scale –Facial Droop –Arm Drift –Abnormal Speech

5. Stroke Mimics Hypoglycemia Alcohol & Drug Intoxication Postictal Hemiparesis Complicated Migraines

6. Treatment for Acute Stroke Tissue Plasminogen Activator (tPA) – Must be administered within 3 hours of symptom onset for optimal outcomes. Recognition of acute signs and symptoms in the pre-hospital phase could greatly enhance the intervention and outcome of these patients.

7. tPA-Exclusions Patient exclusion for possible TPA will expedite ED treatment: – History of internal bleeding –History of past CVA – Recent (within 2 months) trauma or surgery – Severe hypertension – Known bleeding disorders – Pregnancy