When EMS suspects a stroke, transport the patient to the hospital quickly.

Outline (quick map for readers)

• Spot the signs fast: recognizing a stroke in the field

• On-scene priorities: time, glucose check, airway, and little actions that buy minutes

• Why speed beats every other concern: the core reason railroads to definitive care

• A quick note on aspirin and why it’s not the first move

• Getting hospitals ready: pre-notification and a clean handoff

• In transit: keeping the patient stable and focused

• Common traps and real-world tips

• Wrap-up: the bottom line and how to stay sharp

Stroke on the radar: what EMS should do the moment you suspect it

When someone starts slipping into a stroke, every second matters. EMS personnel are often the first to catch the signs, and your response sets the course for treatment that can save brain tissue and restore function. The correct move isn’t second-guessing or delaying; it’s getting the patient to definitive care as fast as possible. In most systems, that means transporting promptly to a hospital equipped to handle strokes, with pre-notification so the ER can jump right into CT scans and critical decision-making as soon as you arrive.

Recognize the signs without overthinking it

Think about the classic “FAST” screen—face, arms, speech, time. You don’t need a memory shuffle to do this in real life. Ask the patient to smile and show teeth (face symmetry), hold both arms out (do they drift or drop one side), and have them describe something simple or repeat a sentence to check slurred speech. If any of those are abnormal, time to act.

Some teams also use the Cincinnati Prehospital Stroke Scale (CPSS), which tweaks the questions a bit but sticks to the same idea: you’re hunting for facial droop, arm weakness, and speech abnormalities. Either way, the moment you spot symptoms, your mindset shifts to “time is brain.” That shift matters more than any discussion about etiology at the curb.

On-scene actions that buy precious minutes

• Don’t turn on a million bells and whistles trying to solve every mystery. Focus on the essentials: airway, breathing, circulation, and the time of onset.

• Check the patient’s blood glucose. Hypoglycemia can mimic stroke, and a low reading can be corrected quickly. If glucose is low, treat, then reassess; if it’s normal, don’t pretend the problem isn’t bigger.

• Assess airway and provide oxygen only if needed. If SpO2 is under 94%, give supplemental oxygen. If the patient is breathing adequately, there’s no need to over-oxygenate.

• Place the patient in a position that keeps their airway clear and reduces aspiration risk. If they’re nauseated or vomiting, a shallow elevation of the head can help, but keep the airway protected.

• Gather key timing information without stalling transport. “Last known well” is the crucial detail. If you can’t determine onset, you still treat it as time-sensitive; don’t delay to chase every possible history.

• Start IV access early if you can, not to kit it as theater, but because it may speed up ED care if IV analgesia or other medications are needed. In most stroke protocols, you won’t push drugs on scene beyond basic supportive care, but you’ll want a lane ready for the hospital to run with.

Why speed is the main course here (and what you should never do first)

Let me connect the dots with plain terms: the sooner a stroke patient gets imaging and a decision on therapy, the better the outcome. That means rapid transport is the top priority. Here’s why other actions commonly thrown into the mix don’t beat speed:

• Detailed history can wait. It’s valuable, but it doesn’t improve outcomes on the steep slope of time. Gather what you can on scene, then hand off precise details to the receiving team.

• Pain management isn’t the lead actor. A stroke patient may be uncomfortable, but pain relief isn’t going to fix the stroke. Focus on preserving brain function and facilitating rapid hospital care.

• Aspirin on scene? Not the default move. Because you don’t know whether the stroke is ischemic or hemorrhagic, giving aspirin can carry risk if the stroke is hemorrhagic. Hospitals will determine if aspirin is appropriate after imaging.

The hospital handoff starts before you arrive

Pre-notification is more than a courtesy; it’s a lifeline. A quick call to the receiving ED with essential facts can shave minutes off the overall timeline. Include:

• Estimated time of onset or last known well

• CPSS or FAST findings

• Vital signs and mental status

• Blood glucose level

• Current medications and allergies

• Any contraindications to stroke therapies the hospital should know

• Airway status and need for advanced support

If you’ve got the option, route the patient to a hospital with a recognized stroke program or center. If your system has stratified destinations, mention the correct level of stroke center so the team can anticipate CT, possible thrombolysis, or thrombectomy considerations.

What to do in transit to keep the patient stable

The ride to the hospital is not just a corridor; it’s a critical phase where you sustain life and keep the condition from worsening. A few practical habits help:

• Monitor vitals continuously and reassess frequently. Blood pressure, heart rate, rhythm, oxygenation, and glucose should be tracked. Abnormal trends can guide the ED’s immediate actions.

• Keep IV access ready but don’t flood the patient with fluids unless there’s a clear reason. In some strokes, aggressive IV fluids aren’t helpful and can worsen edema; the ED will guide fluids based on imaging and labs.

• Avoid giving medications unless there’s a clear, protocol-based reason. The goal is to reach the imaging suite swiftly, not to micromanage symptoms that won’t alter the course of treatment.

• Maintain patient comfort without compromising care. A calm, reassuring presence reduces anxiety for the patient and helps you manage the scene more effectively.

• If the patient is conscious, engage in minimal conversation to gather information without delaying care. If the patient loses responsiveness, shift to monitoring and preparing for rapid transport.

Common traps and sensible tips from the field

• The “we’ll sort it out later” impulse can be tempting, but it costs minutes. Treat the situation as time-critical until you’ve delivered the patient to definitive care.

• Don’t let the clock force you into unsafe conditions. If the route requires a detour to drop someone off at a non-equipped facility, reconsider. It’s not about heroic multitasking; it’s about making smart, rapid choices that protect the patient.

• Be mindful of stroke mimics. Seizures, migraine with aura, hypoglycemia, or even a sudden confusion from other illnesses can resemble a stroke. Your job is to rule in the stroke and rule out major mimics quickly, mainly through history, exam findings, and glucose checks.

• Documentation matters. A crisp, on-scene narrative helps ED clinicians piece together the timeline, onset, and symptoms—crucial for deciding whether the patient is a candidate for thrombolysis or thrombectomy.

• Team communication is everything. If you’re working with partners or ALS backup, keep roles clear and share critical updates as you run.

The bottom line: D is the move that fits the moment

In simple terms: when a patient looks like they’re having a stroke, transport quickly. The goal is to get the patient to a hospital where a CT scan and a specialist team can determine if clot-busting treatment or mechanical removal is appropriate. This isn’t about a checklist; it’s about a mindset. Time becomes a resource you protect rather than waste.

A few closing thoughts you can carry to every run

• Stay curious, but act fast. You don’t need to solve every riddle at the curb—your job is to initiate the chain of care that unlocks rapid treatment.

• Keep the patient and their family informed as you can. Clear explanations reduce fear and help them participate in the care decisions when they regain clarity.

• Practice, drill, and refine. Scenarios that simulate stroke can hard-wire fast decision-making without sacrificing safety. Your local EMS training program likely runs these, and they’re worth every minute.

• Remember your own rhythm. Even a calm, steady pace on a high-stakes call helps you maintain focus and accuracy when every second counts.

If you’re an EMS professional or student diving into the world of emergency response, keep this in mind: in stroke care, speed and precision are teammates. The fastest path from symptom onset to definitive treatment is paved by a well-coordinated response, crisp on-scene assessment, and a sharp handoff to hospital teams. That’s the backbone of improved outcomes and better lives after a stroke.

If you’re looking to sharpen your response, review your local stroke protocol, run through a few real-world scenarios with your crew, and stay updated on the latest guidance from stroke centers in your area. The more you practice, the more natural it becomes to act decisively when time is precious. And when you do, you’re not just moving a patient; you’re buying precious moments that can change a life.