EMS is called to the scene of a “possible stroke”. The patient is a 75 yo female who was last known normal at 8 pm the night before when she went to bed with plans to watch TV before going to sleep. She fell when she tried to get out of bed at 7 am. Her daughter lives with her and heard her fall. When she came into the room, she noted that her mother had a right facial droop, right arm and right leg weakness. She also was unable to speak coherently. The ambulance arrives on scene at 7:30 am and the EMT performs a Cincinnati stroke scale and confirms the findings reported by the patient’s daughter.
The patient lives 20 minutes away from a community hospital which is designated as a primary stroke center. The comprehensive stroke center with endovascular capability is located an hour away.
Where should the patient be taken? What pre-notification alarm bells should be rung? What criteria should EMS systems use to make these transportation decisions in a way that best serves patients without overburdening both the EMS system and comprehensive stroke centers?
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