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It defines key concepts including Stroke Alert, LVO Alert, Large Vessel Occlusion, TLKW, and Subacute Stroke, then sets triage rules using Cincinnati Stroke Scale (CSS) and the Vision-Aphasia-Neglect (VAN) screen. The policy specifies decision logic by TLKW thresholds, north vs. south zone transport destinations, and exceptions such as ROSC to STEMI receiving centers and CT or disaster diversion.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/stroke-system-triage-and-destination/363396/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/stroke-system-triage-and-destination/363396.png","ImageObject",300,407,{"name":92,"@type":93},"lilac","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",15,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"How is a suspected acute stroke patient triaged in the pre-hospital setting?","Question",{"text":113,"@type":114},"The patient is assessed with the Cincinnati Stroke Scale (CSS). If arm drift is present on CSS, the VAN assessment is performed to support alert classification and destination decisions.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What makes a patient a Stroke Alert versus a LVO Alert?",{"text":118,"@type":114},"A Stroke Alert requires a positive Cincinnati Scale with a negative VAN and TLKW less than 24 hours. A LVO Alert requires a positive VAN assessment (including arm drift on CSS and a positive VAN screen) with TLKW less than 24 hours.",{"name":120,"@type":111,"acceptedAnswer":121},"Where should patients be transported based on TLKW and zone (north vs. south)?",{"text":122,"@type":114},"For north zone, all Stroke and LVO Alerts go to the closest ASC regardless of anticoagulant use. For south zone, TLKW thresholds determine transport, including potential transport to SBCH when on anticoagulants with TLKW less than 4.5 hours.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},363396,1790621046,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52},3985747861865,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","STROKE SYSTEM TRIAGE AND DESTINATION  \nI. Purpose: To outline the process of pre-hospital triage and transport of suspected acute stroke patients to facilities designated as an Acute Stroke Center (ASC) .  \nII. Authority: California Health and Safety Code , Sections 1797.220 & 1798. California Code of Regulations, Title 22, Sections 100147 , 100148 , 100270.220 and 100270.222.  \nIII. Definitions:  \nA. Acute Stroke Center (ASC): Hospitals are designated as an Acute Stroke Center (ASC), as defined in Policy 650 – Stroke Care System General Guidelines.  \nB. Stroke Alert: An early notification by EMS Personnel to the ASC that a patient is suffering a possible acute stroke.  \nC. Large Vessel Occlusion (LVO): The obstruction of a large cerebral artery that typically produces severe stroke symptoms.  \nD. Large Vessel Occlusion (LVO) Alert: An early notification by EMS Personnel to the ASC that a patient is possibly suffering from a severe form of a stroke.  \nE. Stroke System Criteria: A patient that meets “Stroke Alert” or “LVO Alert” criteria per SBCEMSA Policy 533-21 – Stroke.  \nF. Subacute Stroke: A patient with new stroke symptoms , but with a TLKW > 24 hours.  \nG. Time Last Known Well (TLKW): The date/time at which the patient was last known to be without signs and symptoms of the current suspected stroke.  \nIV. Policy:  \nA. STROKE SYSTEM TRIAGE:  \n1. A patient meeting criteria in each of the following sections (a, b, and c) shall be triaged into the Santa Barbara County Stroke System and transported to the appropriate facility per the procedure outlined below.  \na. Blood glucose level (BGL) is greater than sixty (60) OR patient continues to exhibit signs and symptoms of an acute stroke after prehospital treatment of abnormal blood glucose levels.  \nb. Identification of any abnormal finding of the Cincinnati Stroke Scale (CSS):  \ni. Facial Droop  \n1) Normal: Both sides of face move equally  \n2) Abnormal: One side of face does not move normally  \nii. Arm Drift  \n1) Normal: Both arms move equally or not at all  \n2) Abnormal: One arm drifts down compared to the other  \niii. Speech  \n1) Normal: Patient uses correct words with no slurring  \n2) Abnormal: Slurred or inappropriate words or mute  \nc. Identification of any abnormal finding of the Vision, Aphasia, Neglect (VAN) Screen:  \ni. Visual Disturbance  \n1) Normal: Ability to see in all directions (up, down, left, right)  \n2) Abnormal: There is vision loss (partial or complete)  \nii. Aphasia  \n1) Normal: Ability to communicate clearly & understand simple commands  \n2) Abnormal: Inability to communicate clearly, is mute, or cannot understand commands  \nNote: Aphasia is NOT slurred speech  \niii. Neglect  \n1) Normal: Ability to track surroundings & all peripheral sensation is intact  \n2) Abnormal: Looks to one side or ignores stimulus to one side of the body  \n2. First Responders will adhere to Policy 508 – Do Not Resuscitate/POLST Form Orders to establish information regarding Advanced Directives.  \nV. Procedure:  \nA. Assessment:  \n1. In patients with suspected stroke:  \na. Perform Cincinnati Stroke Scale (CSS);  \nb. If patient has arm drift on CSS , immediately perform VAN assessment  \nB. Stroke Alert  \n1. If Cincinnati Scale is positive, but VAN is negative, and TLKW is \u003C 24 hours, then patient is a Stroke Alert.  \nC. LVO Alert  \n1. If the patient has a positive VAN assessment (arm drift on CSS and a positive VAN screen) , and TLKW is \u003C 24 hours, then patient is a LVO Alert  \nD. Cincinnati Positive and TLKW >24  \n1. Subacute stroke, not an Alert , but shall be transported to the closest ASC.  \nE. Transportation Considerations  \n1. All Stroke Alerts and LVO Alerts in the north zone will be transported to the closest ASC  \n2. All Stroke Alerts in the south zone will be transported to the closest ASC , unless patient takes an anticoagulant and TLKW is \u003C 4.5 hours (see below & flow chart on Attachment A) .  \n3. Anticoagulant Use  \na. North Zone: All Stroke and LVO Alerts will be transpo","cbCaikJUUDVomwEA","https://ap.wps.com/l/cbCaikJUUDVomwEA","pdf",210367,"English","# Purpose\n# Authority\n# Definitions\n## Acute Stroke Center (ASC)\n## Stroke Alert and LVO Alert\n## Stroke System Criteria\n## Time Last Known Well (TLKW)\n# Policy\n## Stroke System Triage\n## Policy Criteria by CSS and VAN\n## Procedure\n### Assessment\n### Stroke Alert determination\n### LVO Alert determination\n### Subacute stroke transport\n### Transportation considerations\n### Identification of a Stroke or LVO Alert\n### Destination decision and exceptions","[{\"question\":\"How is a suspected acute stroke patient triaged in the pre-hospital setting?\",\"answer\":\"The patient is assessed with the Cincinnati Stroke Scale (CSS). If arm drift is present on CSS, the VAN assessment is performed to support alert classification and destination decisions.\"},{\"question\":\"What makes a patient a Stroke Alert versus a LVO Alert?\",\"answer\":\"A Stroke Alert requires a positive Cincinnati Scale with a negative VAN and TLKW less than 24 hours. A LVO Alert requires a positive VAN assessment (including arm drift on CSS and a positive VAN screen) with TLKW less than 24 hours.\"},{\"question\":\"Where should patients be transported based on TLKW and zone (north vs. south)?\",\"answer\":\"For north zone, all Stroke and LVO Alerts go to the closest ASC regardless of anticoagulant use. For south zone, TLKW thresholds determine transport, including potential transport to SBCH when on anticoagulants with TLKW less than 4.5 hours.\"}]","STROKE SYSTEM TRIAGE AND DESTINATION | PDF",1790151064]