The bulk of prehospital stroke management has not changed drastically between this year and last. The majority of these calls, like with trauma cases, are handled by BLS units since there are more of them in the city; this increases the likelihood of immediate, rapid transport to a definitive care center, which is ultimately what these patients need.
A few important takeaways:
1. Any patient with a suspected CVA should be receiving a prehospital glucose measurement, regardless if they’re with a BLS or ALS crew, for the same reason why we check BGM in the ED during stroke codes.
2. The attached appendix elaborates on the NYC S-LAMS score, which is the go-to prehospital stroke scale in New York City, derived largely from components of the two other major scoring criteria used in the US: The Cincinnati Stroke Scale and the Los Angeles Motor Scale. Look at the attached flowsheet for specifics, but essentially –
a. if S-LAMS is >= 4 and no exclusion criteria present, the patient has a high concern for acute LVO and should pass potentially closer hospitals to go to the nearest thrombectomy-capable center
b. if not, the patient should be either brought to a Primary Stroke Center (that can provide medical stroke care, thrombolysis, but not thrombectomy) or a non-stroke center ED, depending on the presentation
c. you are NOT expected to know which hospitals are Primary Stroke Centers vs Comprehensive (Thrombectomy) Stroke Centers vs general EDs, BUT you should be able to assist crews that call OLMC to determine which TYPE of destination WOULD be appropriate, after which they can work with their own dispatch to determine which hospital to go to; again, refer to the flowsheet for specifics
3. One NEW feature in this year’s protocol is the addition of metoprolol, 5mg slow IV push, as a Medical Control Option for patients hypertensive to >210/120 (assuming ALS providers are present). As with other MCOs, listen to the crew’s entire presentation, use your discretion, and make sure to utilize great closed-loop communication in your orders.
As always, reach out with questions/comments/concerns, make the most of www.nycremsco.org and the protocol binder, and we’ll see you next week!
Dave