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Arrival via EMS at the closest ED capable of delivering fibrinolytic as soon as safely possible

EMS should provide notification while en route to receiving hospital for suspected stroke patients

Rapid assessment by stroke team or emergency physician

Completion of computed tomography (CT) scan within 20 minutes

Administration of fibrinolytic (tPA) within 60 minutes of arrival to ED and within 4.5 hours of symptom onset for eligible patients

Source: Modified from Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018; 49:e46–e99.

All of these treatments for stroke have potentially devastating complications, the most noteworthy being intracranial bleeding. In addition, these interventions have several exclusion criteria that must be considered when selecting patients, but are beyond the scope of this chapter. Nonetheless, it is important that EMS clinicians have at least a general understanding of available stroke treatments, as well as the rationale for accurate and rapid identification of the stroke victim. Box 18.3 describes the current AHA/ASA time‐to‐treatment goals related to IV tPA. Ideally, the time window from ED arrival to drug administration should not exceed 60 minutes [9].