DATE: January 3, 2008
Guidelines for the transport of all patients with suspected acute onset of stroke or
Cerebral Vascular Accident (CVA) including transient ischemia attack (TIA)
This Medical Advisory augments the current Williamson County Scope of Care for transport of
patients with stroke signs or symptoms. It is intended to assist the paramedic in deciding the
best approach to provide comprehensive care for a stroke patient.
Three are three levels of Stroke Center Classifications developed by the Department of State
Health Services (DSHS), and The American Heart Association.
Level I (Comprehensive): These centers are able to treat all aspects of stroke including
diagnostics with CT or MRI imaging, thrombus management; including neurosurgical
intervention. Seton (38th St.), St. David’s (32nd St.), Brackenridge, and Scott and White Temple
are all Level I (Comprehensive) stroke centers.
Level II (Primary): These centers are able to treat most aspects of stroke with supportive
therapies including diagnostics with CT or MRI imaging, and thrombus management, but
exclude neurosurgical intervention. Seton Northwest recently achieved Primary / Level II Stroke
Level III (Support Facilities): These centers provide supportive care and usually immediately
transfer patients to Level I or II centers. These support facilities may or may not have diagnostic
capabilities and rarely have the ability to manage thrombus strokes nor have neurosurgical
Williamson County EMS Paramedics shall use the Los Angeles Prehospital Stroke Screen
Protocol when assessing any patient with a potential stroke.
Any patient greater than 18 years of age with signs or symptoms of stroke
including TIA with an onset of LESS THAN 120 minutes will be transported to a
Level I – Comprehensive Stroke Center.
Patients greater than 18 years of age with signs or symptoms of stroke including
TIA with an onset GREATER THAN 120 minutes may be transported to a lower
level stroke center.
Patients less than 18 years of age with signs or symptoms of stroke will be
transported to Dell’s Children’s Hospital.
Special Consideration: If the transport time to a Level I Stroke Center takes longer than 30
minutes, the paramedic may consider transportation to a lower level center if the patient’s
condition is stable. Remember that hemorrhagic cerebral events (absent of trauma) will
generally require transfer to a Level I Stroke Center.