Stroke Program for Brooklyn and Queens
Stroke Centers
Stroke Assesment

Rapid identification of the signs and symptoms of acute stroke may provide opportunities for improved patient care, including the possible utilization and benefits of thrombolytic therapy.
Administration of thrombolytic therapy is required within 3 hours of stroke onset in order for treatment to be safe and potentially effective.
FDNY is collaborating with the NYS DOH to evaluate whether early recognition, transport, and treatment of acute stroke patients at designated Stroke Centers can be accomplished in an appropriate and effective fashion.
The Stroke Center pilot program will begin at 0001 hours, Tour 1, on May 5, 2003 and will continue for approximately six (6) months.

PREHOSPITAL STROKE SCALE

The PSS shall also be used to determine the time elapsed from initial onset of symptoms of stroke to arrival of EMS on-scene.
All providers are required to ask the patient, and/or bystanders/family members, the following question(s):
A. To bystanders/ family members: “What time was ________ (the patient) last seen (in his/her usual state of health) before he/she became weak, paralyzed or unable to speak clearly.
B. To patients: “When was the last time you remember being in your usual state of health – in other words, before you first noticed that you had become weak, paralyzed or unable to speak clearly”.

Any ‘abnormal’ finding on the PSS shall be used by prehospital care providers to identify patients with suspected “stroke”.
If the time from onset of symptoms to EMS arrival on-scene is 2 hours or less, then the ‘presumptive diagnosis’ should be recorded as “acute stroke”, and the ‘final call-type’ shall be upgraded, if appropriate, to “CVA-C”.
If the time from the onset of symptoms to EMS arrival on-scene is greater than 2 hours, then the ‘presumptive diagnosis’ should be recorded as “stroke”, and the final ‘call-type’ shall be changed, if appropriate, to “CVA”.
Upon identification of a stroke center candidate, members shall:
Provide treatment in accordance with all applicable REMAC (412) and State approved patient care protocols.
If the patient meets the criteria of an “acute stroke” or a final call type of “CVAC”, transport the patient from the scene to the closest available NYSDOH Designated Pilot Stroke Center unless the closest available 911 Designated Stroke Center is more than twenty minutes away, or the patient is in extremis.
NOTE: If a stroke patient's condition deteriorates to extremis, the patient shall be diverted to the nearest 911 Ambulance Destination.
If the closest available 911 Designated Stroke Center is more than 20 minutes away, transport the patient to the nearest 911 Ambulance Destination.

Advise the dispatcher to which Stroke Center the patient is being transported.
Notify the dispatcher if a stroke patient is being diverted to a nearer 911 Ambulance Destination.
A hospital notification shall be made for any patient with the ‘presumptive diagnosis’ of “acute stroke”or ‘final call-type’ of CVA-C.
The notification shall include the patient’s age, sex, stroke signs and symptoms, vital signs and the estimated time since the onset of symptoms.
All personnel shall clearly document their PSS findings (positive and negative) on the Ambulance Call Report (ACR).
All personnel shall continue to properly document all pertinent patient information on the ACR including history of present illness (HPI), past medical history (PMH), medications, allergies, and BLS/ALS treatment and response.