Mastering the Clock and the Card: Optimizing Field Stroke Assessments & Bypass Protocols

When an acute ischemic stroke occurs, millions of neurons die every minute, making rapid reperfusion therapy the highest priority. The Paramedic Prompt Card for Acute Stroke Bypass Protocol (see image below) acts as the guideline for this life-altering care, assisting paramedics to determine when to bypass local hospitals in favor of designated Regional Stroke Centers. However, the success of this hinges entirely on the quality of field assessment by paramedics. Accurate Identification of the Last Seen Normal (LSN) window, swift calculation of large vessel occlusion (LVO), and medical history are what allow the emergency department stroke teams to immediately assess and determine the appropriate treatment including the administration of thrombolytic medication like Tenecteplase (TNK) or other potential treatment pathways.

By the end of this tip, paramedics will be able to accurately calculate and document a patient’s LSN time, correctly apply the LAMS score for LVO screening, and gather the critical anticoagulant data required to optimize the acute stroke bypass.

Amputations are high-acuity, time-sensitive injuries that can occur in a wide range of environments; from industrial and farm machinery to motor vehicle collisions, power tools, and even sharp-force trauma. The mechanism can vary significantly, from clean surgical-like separations to severe crush or avulsion injuries, each presenting unique challenges for prehospital care. Regardless of the cause, early recognition and proper management are critical to patient outcomes. Effective hemorrhage control, preservation of the amputated part, when possible, and rapid transport decisions all play a vital role in improving survival and the potential for reattachment.

This month’s Tip of the Month is intended to support paramedics in assessing and prioritizing management of traumatic amputations, including effective hemorrhage control and appropriate preservation of the amputated part, in accordance with Ontario BLS and ALS-PCS standards.

"Can you open your eyes for me?"

If a patient opens their eyes when you speak to them, are they automatically a GCS 14?

Not necessarily. Accurate scoring depends on how and why the response occurs

Seizures result from abnormal, excessive neuronal activity in the brain and may be provoked (e.g., hypoglycemia, hypoxia, electrolyte imbalance, toxic exposure) or unprovoked (e.g., epilepsy). Seizure presentations vary widely, and not all seizure-like activity represents epileptic disease. Most generalized seizures are self-limiting and resolve within 1 to 2 minutes, followed by a post-ictal period. The role of paramedics is to identify seizure type, treat reversible causes, terminate active seizures when indicated, and determine the appropriate disposition. Under ALS-PCS v5.4, selected patients who have returned to baseline may be considered for treat and discharge, provided strict criteria are met.