Authority: IC 16-31-2-9.5

Affected: IC 10-14-3-12; IC 16-18; IC 16-21-2; IC 16-31-2-9; IC 16-31-2-9.5; IC 16-31-3; IC 25-22.5-1-1.1; IC 25-23-1-1.1

Sec. 3. (a) Ambulance service provider organization and nontransport provider organization medical directors shall develop protocols that address the identification, transport destination determination, and treatment protocols specifically addressing stroke as part of the medical director responsibilities in creating protocols.

(b) After an emergency medical dispatch agency, through the process of emergency medical dispatch, determines the possibility of a stroke and notifies responding emergency medical services units, the emergency medical services crews shall then be dispatched per dispatch protocols.

(c) Upon emergency medical services personnel arrival at the scene of a patient with suspected stroke, an emergency medical services provider must perform and document the following:

1. (1) An initial stroke assessment utilizing a stroke screening tool, as listed in section 2(3) of this rule and as approved by protocol.
2. (2) Obtain a blood glucose, if available.
3. (3) Identify and document time of last known well time and time of symptom discovery.

(d) If the patient screens positive for a stroke during the assessment with the initial stroke screening tool, the provider may then perform, if approved by protocol, an evidence-based nationally recognized Large Vessel Occlusion (LVO) Stroke Scale assessment, such as Rapid Arterial Occlusion Evaluation (RACE), Field Assessment Stroke Triage for Emergency Destination (FAST-ED), and Cincinnati Stroke Triage Assessment Tool (C-STAT).

(e) Patients determined to need stroke center care, by virtue of their stroke screening tool, shall be transported to an appropriate stroke capable hospital as determined by the provider organization's medical protocol, which shall consider the following:

1. (1) Capability to administer tissue plasminogen activator (such as alteplase) accurately, promptly, and safely.
2. (2) Nationally recognized evidence-based science.
3. (3) Nationally recognized guidelines.
4. (4) The list of available certified stroke centers published by the Indiana state department of health pursuant to IC 16-31-2- 9.5(b).

(Indiana Emergency Medical Services Commission; 836 IAC 1-2.2-3; filed Oct 31, 2019, 9:51 a.m.: 20191127-IR- 836190172FRA; readopted filed Jul 24, 2024, 3:48 p.m.: 20240821-IR-836230827RFA)