Leveraging Stroke Scales to Improve Patient Care

  • Posted on May 3, 2019

Stroke is the leading cause of morbidity and mortality in the United States, meaning there is an increased need for EMS to recognize the signs of a stroke in prehospital settings in order to provide the best stroke care for patients. There are approximately 210 strokes reported in the ESO platform every day, which equals one percent of cases. The average EMT might only see one to two stroke cases per year, so the right tools and procedures must be in place to help EMTs when they are treating a patient who is having a stroke. 

One of the quickest ways to see if your patients are encountering a stroke is to use evidence-based decision protocols including stroke scales to rapidly assess for stroke and move the patient to the best care facility for their needs. While there are variations across all stroke scales, there are, of course, commonalities between them, as well. Checking facial droop, arm motor function, slurred speech, and last time known well are commonly evaluated by most stroke scales. Stroke scales have been shown to regularly predict actual stroke. In fact, the Rapid Arterial oCclusion Evaluation (RACE) scale has been shown to identify stroke in 85% of patients with a score of 5 or higher on the scale.  

By determining if your patient is having a stroke earlier, you can warn the receiving facility about your patient’s case sooner. Your ePCR should have all of the common stroke scales handy. This allows you to put your employer’s approved scale in place to make evaluating stroke patients easier when you’re in the field.  

Although there is no perfect stroke scale, ESO has all of the common stroke scales available in ESO Electronic Health Record’s Forms feature.  All you need to do is enter your evaluation into the tool and the platform will walk you through the assessment process. While the most common stroke scale is the Cincinnati Stroke Scale, ESO also provides EMTs with access to the Los Angeles Prehospital Stroke Screen, the Miami Neurologic Deficit Checklist, and more. 

Additional Tips For Improving Stroke Care 

Since May is National Stroke Awareness Month, now is a good time to review your stroke care protocols and ensure that staff is trained on how to appropriately respond to stroke. Here are four tips for improving stroke care in your EMS agency. 

  1. Review the hospital outcomes of patients your hospital partner diagnosed as having a stroke. Do your agency’s primary impressions match? If not, what was missed and how can this inform your training? 
  2. Train crews on the four levels of stroke care facilities and which hospitals in your area meet the criteria for each. Do your crews know which patients are appropriate for which hospitals? 
  3. Enact practice cases followed by group discussion on what went well and what needs improvement. 
  4. Watch videos of people encountering stroke and discuss how you would leverage a stroke scale in the field.