Cerebral Vascular Accident
EMS Quick Reference

If you suspect stroke (Cerebral Vascular Accident) contact the emergency department at the intended receiving facility and include the following information:

1. Time last seen normal and If less than 6 hours
2. Signs and Symptoms
3. Blood glucose results
4. Results of The Cincinnati Prehospital Stroke Scale.

                                                                                                                     

The Cincinnati Prehospital Stroke Scale
(Kothari R, et al, Acad Emerg Med. 1997; 4:986-990.)

Facial Droop (have patient show teeth or smile):
• Normal – both sides of face move equally well
• Abnormal – one side of face does not move as well as the other side
Arm Drift (have patient close eyes and hold both arms out, palms up):
• Normal – both arms move the same or both arms do not move at all
• Abnormal – one arm does not move or one arm drifts down compared with the other
Speech (have the patient say “you can’t teach an old dog new tricks”):
• Normal – patient uses correct words with no slurring
• Abnormal – patient slurs words, uses inappropriate words, or is unable to speak

If any 1 of these 3 signs is abnormal, the probability of a stroke is 72%

Additional Possible stroke Signs and symptoms:
• Sudden onset visual disturbance
• Loss of speech, difficulty speaking or understanding speech
• Sudden onset of unilateral numbness
• Symptoms of unexplained dizziness, falling, or loss of coordination

 5. Encourage a close family member to accompany the patient to the hospital to provide information on baseline function, onset of symptoms, and consent for treatment. If family member is unable to accompany the patient to the hospital, obtain their name and a good phone number.

The Recommend EMS Response Time Goals:
Cerebral Vascular Accidents:< 9 minutes to the scene, <15 minutes on-scene
(Acker, JE III, et al.  Stroke. 2007; 38(11):  3097 – 3115.)