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Paramedic Prompt Card for Acute Stroke Bypass Protocol

This prompt card provides a quick reference of the Acute Stroke Protocol contained in the Basic Life Support Patient Care Standards (BLS PCS). Please refer to the BLS PCS for the full protocol.

Indications under the Acute Stroke Protocol

Redirect or transport to the closest Designated Stroke Centre* will be considered for patients who meet ALL of the following:

  1. Present with a new onset of at least one of the following symptoms suggestive of the onset of an acute stroke:
    1. Unilateral arm/leg weakness or drift.
    2. Slurred speech or inappropriate words or mute.
    3. Unilateral facial droop.
  2. Can be transported to arrive at a Designated Stroke Centre as follows:
    1. if Endovascular Therapy (EVT) is not regionally available, within 4.5 hours of a clearly determined time of symptom onset or time the patient was last seen in his/her usual state of health; OR
    2. if EVT is regionally available, within 6 hours of a clearly determined time of symptom onset or time the patient was last seen in his/her usual state of health.

*A Designated Stroke Center is a Regional Stroke Centre, District Stroke Centre or a Telestroke Centre regardless of EVT capability.

Contraindications under the Acute Stroke Protocol

ANY of the following exclude a patient from being transported under the Acute Stroke Protocol:

  1. CTAS Level 1 and/or uncorrected airway, breathing or circulatory problem.
  2. Symptoms of the stroke resolved prior to paramedic arrival or assessment**.
  3. Blood sugar <3 mmol/L***.
  4. Seizure at onset of symptoms or observed by paramedics.
  5. Glasgow Coma Scale <10.
  6. Terminally ill or palliative care patient.
  7. Duration of out of hospital transport will exceed two hours.

**Patients whose symptoms improve significantly or resolve during transport will continue to be transported to a Designated Stroke Centre.

*** If symptoms persist after correction of blood glucose level, the patient is not contraindicated.

CACC/ACS will authorize the transport once notified of the patient’s need for redirect or transport under the Acute Stroke Protocol.


Ministry of Health and Long-Term Care
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5