The process of stroke identification in the prehospital setting is constantly evolving as stroke treatments become more advanced. Efforts are underway to not only identify patients having a stroke but to consider stroke severity and time from symptom onset in order to triage a stroke patient to the most appropriate receiving facility and to provide important prearrival information to the stroke team. More comprehensive, graded exams may help to identify and quantify specific stroke characteristics that assist the stroke team in determining treatment options. There are also online and smartphone applications that are available for these scales. Unfortunately, these scales are more time consuming and may be more difficult to remember than the earlier stroke assessment tools, but in conjunction with a good patient history, the newer scales can provide a clearer picture of the patient’s condition.

The patient’s medical history is another crucial part of the assessment. Past medical history, including relevant surgeries, medications, and allergies, are critically important and should be documented appropriately. Particular attention should be paid to potential stroke risk factors, such as atrial fibrillation, hypertension, diabetes, previous strokes, transient ischemic attacks, recent surgeries, and smoking [9]. One of the most important elements of the patient’s history is the time of symptom onset, which will dictate many treatment options. The time of onset is based on the last time the patient was known to be “normal” or at their baseline, as opposed to when the patient was found with the neurologic deficits. It is also important to document the patient’s baseline physical and mental state, especially for patients with previous neurologic, physical, or cognitive deficits. To determine last “normal” time, the patient and family members, caregivers or bystanders should be interviewed. If they are unsure about a specific time, inquiry about other time clues such as daily routines, television shows, or recent phone conversations may be helpful [9]. This can help narrow the time window of symptom onset. Other onset factors to consider include activity, headache, trauma, and seizures. These conditions provide clues to the presence of mimics but may also suggest the possibility of intracranial hemorrhage.