(a) Assessment of the Stroke Patient. - (i) Adult patients exhibiting signs and symptoms of a stroke or transient ischemic attack (TIA) shall be assessed with a validated stroke screening scale such as the Miami Emergency Neurologic Deficit (MEND) checklist or the Cincinnati Stroke Scale.
- (ii) EMS providers shall maintain a high index of suspicion that the patient is experiencing a stroke or TIA when the patient is exhibiting signs and symptoms that include, but are not limited to:
- (A) Neurologic deficits, such as facial droop, localized weakness, gait disturbance, slurred speech or altered mentation;
- (B) Hemiparesis or hemiplegia;
- (C) A dysconjugate, forced, or crossed gaze accompanied by a low level of consciousness (LOC), including an inability to follow commands, complete tasks, or make a discernible effort to respond;
- (D) Severe headache, neck pain or stiffness, or difficulty seeing.
- (iii) In assessing a patient exhibiting signs and symptoms of a stroke EMS providers shall:
- (A) Utilize the FAST exam to rapidly evaluate patients;
- (B) Perform a blood glucose analysis;
- (C) Attempt to determine the time of onset of symptoms.
(b) Triage of the stroke patient. - (i) Acute stroke patients shall be triaged to the most appropriate facility based on the index of suspicion formed by the cumulative assessed findings.
- (ii) Notification of a Stroke Alert shall be made as soon as possible to enable the receiving facility to take necessary steps to ensure the facility is prepared to receive the patient.
(c) Treatment of the stroke patient. - (i) For the adult patient exhibiting the signs and symptoms of stroke or TIA, EMS providers shall:
- (A) Provide oxygen only if the patient's oxygen saturation is determined to be less than 94% and titrated to achieve a saturation of 94%;
- (B) Manage seizures according to local protocol;
- (C) Provide glucose only if the patient's blood glucose level is determined to be less than 60 milligrams per deciliter (60mg/dcl);
- (D) Acquire and transmit a 12-lead electrocardiogram (ECG);
- (E) Provide continuous cardiac monitoring.
- (ii) Generally, hypertension should not be treated with pharmacological agents. Management of the blood pressure may include:
- (A) Positioning the patient in the supine position if the systolic blood pressure is less than 120 mmHg;
- (B) Positioning the patient with the head and torso at approximately a 30 degree angle if the systolic blood is greater than 120 mmHg;
- (C) If the patient's systolic blood pressure is greater than 220 mm Hg, and if the heart rate is at least forty-five beats per minute, administer labetalol, ten (10) milligrams every ten (10) minutes, if authorized by scope of practice.
- (iii) Patients exhibiting signs and symptoms of acute stroke shall be considered "nothing passed orally" (NPO), unless the patient is in need of glucose and intravenous glucose cannot be given, and the patient has been cleared for swallowing.
(d) Transport. - (i) Ambulance destination decisions shall be preferential based on the following descending order of preference and capability:
- (A) Comprehensive Stroke Center;
- (B) Primary Stroke Center;
- (C) Acute Stroke Ready Hospital;
- (D) A hospital with an emergency department.
- (ii) Transport to a more distant, designated facility, with a higher level of designation, shall be considered if the additional transport time is less than sixty (60) minutes more than the transport time to the nearest designated facility.
048-15 Wyo. Code R. § 15-6