FIELD REFERENCE
Full criteria & treatment guidance
One positive focal sign can meet the neurologic requirement
- Arm drift or paralysis, new facial droop, and asymmetric grip weakness are joined by OR in SO-M-025. Only one new finding is required, provided the timing and responsiveness requirements are also met.
- Base contact is required for every patient meeting OCEMS stroke-neurology triage criteria.
- Give no oral fluids or solids because of aspiration risk; dissolving ondansetron is specifically permitted.
- This page summarizes the adult/adolescent OCEMS pathway. Do not apply these criteria as a pediatric stroke protocol.
Immediate actions
- Determine the exact last known well time: the last time the patient was observed at their usual neurologic baseline. Obtain the witness's name and callback number when possible.
- Perform all three neurologic checks below and record any positive finding and affected side. Check mental status, gaze, pupils, blood pressure, and blood glucose.
- Apply pulse oximetry, monitor the cardiac rhythm, and document a rhythm strip. If room-air SpO₂ is below 95%, give high-flow oxygen by mask or nasal cannula at 6 L/min as tolerated.
- Keep the patient NPO. Dissolving ondansetron in the mouth is permitted.
- If glucose is below 60 mg/dL, give D10 250 mL IV, or glucagon 1 mg IM if IV access cannot be established.
- For nausea or vomiting when pregnancy is neither known nor suspected, give ondansetron 8 mg ODT, or 4 mg IV; the IV dose may be repeated after approximately 3 minutes if symptoms continue.
Ischemic stroke suspected
- The patient must meet both general requirements: last seen at the usual neurologic baseline within the past 24 hours; and responds appropriately to verbal or visual stimuli, or has spontaneous eye opening.
- The patient must then demonstrate at least ONE of the three new asymmetric findings below. The three findings are alternatives; they do not all need to be present.
- Check all three findings when possible so the receiving team gets a complete examination.
| One or more qualifies | How to check it |
|---|---|
| Arm drift | Have the patient close their eyes and hold both arms straight forward with palms up for about 10 seconds. New pronation, downward drift, rapid fall, or inability to lift one arm is abnormal; state the side. |
| Facial droop | Ask the patient to smile or show their teeth. Compare both sides. A new droop or one side moving less than the other is abnormal; state the side. |
| Grip weakness | Ask the patient to squeeze both hands at the same time. Compare sides and confirm the difference is new. New asymmetric weakness is abnormal; state the weaker side. |
Intracerebral hemorrhage suspected
- History available: sudden, severe headache beginning within the past 24 hours plus at least one of the following: repeated vomiting, a neurologic deficit, altered mental status, or diastolic BP above 100 mm Hg.
- History unavailable because of altered mental status: at least one of the following may qualify the patient - repeated vomiting without another obvious cause, a neurologic deficit, diastolic BP above 100 mm Hg, or paramedic judgment of an acute intracerebral bleed.
Base contact & destination
- Base contact is required for every OCEMS stroke-triage designation so the receiving facility can prepare its stroke team.
- Coordinate the Stroke-Neurology Receiving Center destination through base. If the patient does not meet stroke-triage criteria, provide ALS transport to the nearest emergency receiving center.
View the current OCEMS Stroke-Neurology Receiving Center list →
Access, reassessment & documentation
- Avoid IO and external-jugular access in a potential Stroke-Neurology Receiving Center patient because bleeding at those sites may be difficult to compress if the patient receives thrombolytics.
- The IO dextrose exception requires an unconscious patient with glucose below 60 mg/dL, inability to establish IV access, and no response to IM glucagon.
- Repeat the neurologic exam and document changes. Record the actual finding and side rather than only writing 'stroke positive.'
- Document last known well, symptom-discovery time, witnessed onset when known, witness name and callback number, mental status, glucose, blood pressure, oxygen saturation, rhythm, treatments, response, base contact, and destination.
VISUAL FIELD REFERENCE
Ischemic stroke: both requirements + one finding
Adult / adolescent · ALS
This diagram covers the suspected ischemic-stroke branch. The hemorrhage criteria are separate below.
BOTH general requirements (AND)
- Within 24 h
Last known well
last seen at the usual neurologic baseline within the past 24 hours;
Responsiveness
responds appropriately to verbal or visual stimuli, or has spontaneous eye opening.
PLUS at least ONE new asymmetric finding (OR)
Arm drift
Have the patient close their eyes and hold both arms straight forward with palms up for about 10 seconds. New pronation, downward drift, rapid fall, or inability to lift one arm is abnormal; state the side.
Facial droop
Ask the patient to smile or show their teeth. Compare both sides. A new droop or one side moving less than the other is abnormal; state the side.
Grip weakness
Ask the patient to squeeze both hands at the same time. Compare sides and confirm the difference is new. New asymmetric weakness is abnormal; state the weaker side.
- Base contact is required for every OCEMS stroke-triage designation so the receiving facility can prepare its stroke team.
- This page summarizes the adult/adolescent OCEMS pathway. Do not apply these criteria as a pediatric stroke protocol.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-M-025 · 310.00 · 240.20 · 310.96
UNDERSTAND THE CARE
Why last known well is different from discovery time
Last known well is the last observed usual neurologic baseline, not necessarily the moment symptoms were noticed. Record both when they differ, and obtain a witness callback number when possible. Describe the exact deficit and side instead of documenting only “stroke positive.” The local ischemic triage criteria combine timing and responsiveness with at least one of the listed new asymmetric findings.
Applying the guidance
The three neurologic findings are alternatives, but checking all of them gives the receiving team a more complete examination. Repeat the assessment after glucose treatment or any clinical change. Suspected intracerebral hemorrhage has separate history-available and history-unavailable criteria. Base contact and destination planning accompany a qualifying triage designation.
Putting it together
Teaching example: a patient wakes with a new deficit. Record the last observed normal baseline separately from awakening and discovery, then apply the source criteria using the actual history.
Diagram text & teaching checkpoints
- Time
- Last known well and discovery are separate.
- Examination
- Perform all checks; one new asymmetry can qualify.
- Other criteria
- Timing, responsiveness, glucose and ICH branch.
- Destination
- Base-coordinated stroke-neurology receiving center.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.