Stroke Recognition and Transport Decisions for EMS
Cincinnati and LAMS scales, last known well, and how to pick between a primary stroke center and a comprehensive stroke center under time pressure.
March 19, 2026 · 7 min read
Time is brain. Every 15 minutes of delay in reperfusion costs a stroke patient measurable independent living time. EMS makes or breaks the door-to-needle clock.
The Cincinnati Prehospital Stroke Scale
Facial droop, arm drift, and speech. Any one positive finding in a patient without a known cause raises the probability of stroke to over 70%.
Large vessel occlusion screening
Use LAMS, RACE, or your local scale. A LAMS ≥ 4 suggests LVO and should push you toward a comprehensive stroke center (CSC) capable of thrombectomy, even if it means bypassing a closer primary stroke center.
Last known well is the pivotal history
Not "when did you notice?" — when were they last seen normal? Wake-up strokes get the time they went to bed. Get a phone number for a family witness before you leave scene.
Do not give
- Aspirin — no ASA for undifferentiated stroke prehospital.
- Glucose unless documented hypoglycemia.
- Aggressive BP lowering — permissive hypertension is standard until imaging.
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