The Emergency Medical Dispatcher (EMD) acts as the first responder in the chain of survival for a person experiencing a stroke, a medical emergency where time loss equals brain loss. The actions taken by the EMD are critical to the patient’s eventual outcome. The dispatcher’s role is to quickly transition from initial information gathering to recognizing a potential stroke, providing immediate care instructions, and mobilizing specialized resources to ensure the patient receives time-sensitive hospital treatment. Adherence to standardized, scripted protocols ensures that no time is wasted and that field responders and the receiving hospital are fully prepared for the patient’s arrival.
Initial Call Processing and Safety Triage
The first action a dispatcher must take is to confirm the location of the emergency and obtain a reliable call-back number from the reporting party. This process is executed with urgency, even before any medical assessment begins. Securing an accurate address is paramount, as emergency services cannot be dispatched until the location is known.
Once the location is verified, the dispatcher must briefly assess the scene for immediate safety concerns that could affect the patient, the caller, or the arriving EMS personnel. Dispatchers are trained to ask indirect questions about immediate hazards, ensuring the environment is secure. This foundational step guarantees that the responding crew is sent to the correct, safest possible place, preventing delay in their arrival.
Mandatory Stroke Recognition Protocols
The central responsibility of the dispatcher is to quickly identify a potential stroke using structured questioning protocols. These protocols are designed to elicit symptoms that align with common stroke screening tools used in the field, such as those based on the FAST criteria (Face, Arm, Speech, Time). Dispatchers ask the caller to describe the patient’s symptoms, focusing on sudden changes like difficulty speaking, facial drooping, or weakness on one side of the body.
A crucial component of this assessment is determining the “Last Known Well” (LKW) time, which is the exact moment the patient was last seen without any stroke symptoms. This time stamp is the most important piece of information the dispatcher gathers, as it directly dictates the patient’s eligibility for time-dependent treatments, such as intravenous thrombolysis (tPA). Since tPA must be administered within a few hours of symptom onset, the LKW time determines if the patient is within the therapeutic window. Dispatchers must carefully question the caller to distinguish between the time symptoms were discovered and the time the patient was truly last known to be normal.
The dispatcher’s questions often probe for signs of motor weakness and an altered level of consciousness, which are the most common presentations of an acute stroke. Modern systems incorporate motor symptoms, which are present in a large majority of stroke patients. Accurate identification at this stage allows for the highest priority dispatch, ensuring the fastest possible response.
Providing Critical Pre-Arrival Instructions
After initiating the emergency dispatch, the EMD provides Pre-Arrival Instructions (PAIs) to the caller to manage the patient until the EMS crew arrives. These instructions are highly scripted to ensure consistency and maintain the patient’s safety.
A primary instruction involves positioning the patient. The caller is often advised to have the patient lie down with the head slightly elevated, or to place the patient on their side if they are unresponsive or vomiting to maintain a clear airway. The dispatcher also instructs the caller to continuously monitor the patient’s breathing and level of consciousness. This monitoring allows the dispatcher to identify any sudden deterioration and adjust the response priority if necessary.
The caller is also instructed to prepare for the rapid arrival of the ambulance crew by gathering the patient’s medications or medical history information. This preparation minimizes on-scene time for the paramedics, which is essential because any delay in transport directly affects the patient’s treatment timeline. These instructions are given while the units are en route, maximizing the time available for pre-hospital care and transport.
Resource Mobilization and Hospital Alert
The information gathered during the assessment phase is immediately used to mobilize the appropriate level of EMS resource, usually an Advanced Life Support (ALS) unit. The EMD is responsible for continuously updating the responding field units with crucial patient information, including the LKW time and the specific symptoms observed. This continuous communication ensures that the paramedics arrive with a high index of suspicion for stroke and can begin their assessment without delay.
The final, and most time-saving action, is the initiation of a formal hospital pre-notification, commonly known as a “Stroke Alert” or “Code Stroke.” The dispatcher transmits the critical patient data, including the LKW time, to the designated receiving hospital. This early notification allows the hospital to mobilize its specialized stroke team, including neurologists, CT technicians, and laboratory personnel, before the ambulance even arrives.
By activating the Stroke Alert from the dispatch center, the EMD effectively reduces the time it takes for the patient to receive definitive treatment upon arrival. This streamlined process allows the hospital to clear the CT scanner and prepare the thrombolytic medications, upholding the principle that early identification and rapid transport are the most significant actions in improving stroke outcomes. The dispatcher’s role concludes only when the field units have been fully briefed and the hospital is formally alerted to the incoming time-sensitive patient.