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As the first point of contact for EMS systems, a telecommunicator at a public safety answering point has the opportunity to influence the expediency of stroke patient care. In one review of recorded calls to 9‐1‐1, telecommunicators were able to identify and correctly categorize calls as strokes only 31%‐52% of the time. The caller using the word stroke was highly predictive of an actual stroke. The study concluded that telecommunicator recognition of stroke could be improved if key words such as stroke, difficulty communicating, weakness or falling, and facial droop were communicated by the caller [5]. Another study found that, even when the caller used the word stroke, the call was dispatched as a stroke only 48% of the time, and only 41% were dispatched as high priority [6]. The most frequently reported symptoms by callers were speech problems (26%), followed by extremity weakness (22%). Interestingly, fall was stated as the primary problem in 21%. Symptoms such as vertigo or sensory impairment were mentioned much less frequently [7].

Use of a modified stroke scale may help telecommunicators identify potential stroke patients and ensure appropriate prioritization of calls. The goal is to facilitate patient arrival to an ED as expeditiously as possible to facilitate imaging studies and treatment within a narrow window of opportunity. After sending appropriate resources, the telecommunicator should also provide prearrival instructions to the caller. In addition to providing dispatch life support, telecommunicators can help expedite the time EMS personnel will spend on the scene by preparing the caller for certain important questions. These include past medical history, current medications, allergies, and, most importantly, when the patient was last known to be at his or her neurologic baseline. This information is crucial for EMS clinicians, as they begin to make transport decisions regarding specific receiving facilities. The use of modified stroke assessment tools and software that meet American Heart Association (AHA) and American Stroke Association (ASA) standards may help to identify stroke patients correctly. All telecommunicators should complete formal emergency medical dispatch courses and be certified [8]. (See Chapter 88.)