Question: Recently we were on scene with an unresponsive 65 year old female. This was a witnessed event by a friend. While on route to the nearest ED patients condition improved. The patient started to answer questions. At this time the patient found to have left sided deficits. Should we continue to the local ED (5 min transport) or turn around for stroke bypass (50 min transport) After assessment in ED we ended up transporting to Stroke Unit.

 Thanks for a great question about this challenging case.  From the information provided, this patient had a GCS less than 10 during the call.  Which means that you should proceed to the nearest hospital (per the paramedic prompt card version 2, 2011).  The thinking here is that this patient may have had a seizure, or some other type of spell including an electrolyte abnormality which would require rapid assessment before proceeding down the highway for possibly hours for Ontario paramedics and at least 50 minutes in your scenario.  They could be in danger of another LOC even en route, and this needs to be addressed.  Indeed this patient may still end up being transported to the stroke center, but perhaps with an escort with different skillset, scope and more medications.

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