• Obtain glucose reading via glucometer
• Administer high concentration oxygen, and be prepared to assist ventilations if necessary
• Assess patient with Cincinnati Stroke Scale
  • Facial droop (big smile)
  • Pronator drift (extend arms, palms up, eyes closed: one arm drift = positive; both = unclear)
  • Speech (“The sky is blue in Cincinnati”)
• Assess and record the exact time the patient was last known to be normal
• Encourage a family member to be transported with patient
• Keep patient warm; maintain normal body temperature
• Protect any paralyzed or partially paralyzed extremity
• Obtain a 12-lead EKG
• Pre-notify destination Emergency Department as early as possible
• Consider transport to JCAHO-approved stroke center if onset of symptoms to definitive treatment can be within 3 hours (generally within two hours of symptoms to arrival at facility)
• Transport to closest hospital if: a) cardiac arrest; b) unmanageable airway; or c) other medical condition that warrants transport to the closest hospital per protocol
• Per local protocol, initiate fibrinolytic screening and document findings on Stroke checklist

Updated to 2017 KBEMS Protocol