title: Acute Stroke: Current Evidence-based Recommendations for Prehospital Care.
abstract: BACKGROUND
  In the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California.
  
  
  METHODS
  We performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12-lead electrocardiogram (ECG) and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization.
  
  
  RESULTS
  Protocols across EMS agencies in California varied widely. Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS). All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80 mg/dL. Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification.
  
  
  CONCLUSIONS
  Protocols for a patient with a suspected stroke vary widely across the state of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.
authors.affiliation: University of California San Diego, Department of Emergency Medicine, San Diego, California.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Glober
authors.affiliation: EMS Medical Directors Association of California, California; University of California San Francisco, Department of Emergency Medicine, San Francisco, California.
authors.forename: Karl A
authors.initials: KA
authors.lastname: Sporer
authors.affiliation: University of California San Diego, Department of Emergency Medicine, San Diego, California.
authors.forename: Kama Z
authors.initials: KZ
authors.lastname: Guluma
authors.affiliation: University of California San Diego, Department of Emergency Medicine, San Diego, California.
authors.forename: John P
authors.initials: JP
authors.lastname: Serra
authors.affiliation: EMS Medical Directors Association of California, California.
authors.forename: Joe A
authors.initials: JA
authors.lastname: Barger
authors.affiliation: EMS Medical Directors Association of California, California; University of California San Francisco, Department of Emergency Medicine, San Francisco, California.
authors.forename: John F
authors.initials: JF
authors.lastname: Brown
authors.affiliation: EMS Medical Directors Association of California, California; Stanford University, Department of Emergency Medicine, Stanford, California.
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Gilbert
authors.affiliation: EMS Medical Directors Association of California, California; University of California Irvine, Center for Disaster Medical Sciences, Orange, California.
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Koenig
authors.affiliation: EMS Medical Directors Association of California, California.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Rudnick
authors.affiliation: EMS Medical Directors Association of California, California.
authors.forename: Angelo A
authors.initials: AA
authors.lastname: Salvucci
mesh_terms: D002140:California; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D055317:Evidence-Based Practice / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D020521:Stroke / Q000628:therapy*; D014187:Transportation of Patients