The red phone in resus rings and the nurse tells you: “r/o LVO (large vessel occlusion), LAMS is 5”.
Here in NYC, our EMS uses the Stratified Los Angeles Motor Scale or S-LAMS in the field to help determine where to transport potential stroke patients.
FACIAL DROOP: Absent 0, Present +1
ARM DRIFT: Absent 0, Drifts down +1, Falls rapidly +2
SPEECH DEFICIT: Absent 0, Present +1
GRIP STRENGTH: Normal 0, Weak grip +1, No grip +2
If the score is < 3, the patient should go to the closest primary stroke center.
If the score is > 4, they will call online medical control (OLMC) for a transport decision, often to the closest thrombectomy stroke center (Maimonides is one!). This is because in LVO, endovascular mechanical thrombectomy is the treatment of choice. EMS has to call OLMC to discuss the patient because sometimes there are exclusion criteria for transport to a thrombectomy center.
Time is brain and the S-LAMS scoring system helps get our most concerning patients to the center most suitable to care for them.
