Stroke Symptoms and a Family Request to Drive
At 08:12, a 71-year-old woman is found by her daughter unable to speak clearly and with right-sided facial droop. Symptoms began at 07:40 while she was eating breakfast; the daughter noticed she dropped her coffee cup and could not lift her right arm. She is awake, follows some commands, and has a history of atrial fibrillation and takes apixaban. Her blood pressure is 178/96, heart rate 88, and oxygen saturation 96% on room air. She has no headache, no vomiting, and no known allergies. The daughter wants to drive her to a hospital 25 minutes away because 'the ambulance takes longer.' The nearest hospital is 12 minutes by EMS but is not a designated stroke center; the comprehensive stroke center is 35 minutes away. The dispatcher must sort out chief complaint, transport urgency, and destination.
1. Which chief complaint and response level apply, and how do you handle the daughter's request to drive?
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The chief complaint is stroke, not a generic weakness or 'sick person.' The findings are focal: facial droop, arm weakness, and speech difficulty, with a clear last-known-well time of 07:40. That combination is time-critical and warrants a high-priority ALS response. The anticoagulant history increases concern for hemorrhage but does not lower urgency.
The daughter should not drive. EMS can assess airway, glucose, and stroke severity, prenotify the receiving hospital, and begin transport without the delay of private vehicle parking and triage. The destination question is an EMS/medical decision, not a dispatcher decision made in isolation. The closest hospital may stabilize, but the stroke center may offer thrombectomy or thrombolysis; EMS can weigh transport time and local destination policy. The dispatcher should relay both options and the last-known-well time, keep the caller on the line, and not let the family debate delay the response.
2. What pre-arrival instructions and information should be collected?
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Collect the last-known-well time and confirm it is when the patient was last seen normal, not when symptoms were discovered. Ask about apixaban dose and last dose, recent bleeding, surgery, or falls. Ask whether she can swallow, whether she has vomited, and whether she has chest pain or shortness of breath. Have the daughter gather medications and unlock the door.
Instructions should include keeping the patient calm, lying her on her side if she vomits, and giving nothing by mouth. Do not give aspirin: she is anticoagulated and the stroke could be hemorrhagic. Do not let her eat or drink because swallowing may be impaired. If she becomes unresponsive, monitor breathing and be ready for CPR instructions. The reasoning is that aspiration and bleeding are immediate risks, while aspirin could worsen a brain bleed.
3. If the daughter reports the patient is now sleepy and has vomited, how does that change dispatch?
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This is deterioration with airway risk. Vomiting plus sleepiness in a stroke patient raises concern for aspiration, worsening stroke, or hemorrhage. Upgrade the response if possible, notify EMS of the change, and consider a second unit if local policy supports it. Instruct the daughter to place the patient on her side if it is safe, clear the mouth of visible vomit, and watch breathing. Do not give anything by mouth.
The reasoning is that the patient can no longer be assumed to protect her airway. Dispatch should not wait for a callback or a later update. Keep the caller on the line, confirm the door is unlocked, and tell EMS the patient has vomited and has a decreased level of consciousness. If she stops breathing normally, switch to CPR instructions.