Stroke Paper

The VAN Stroke Assessment

Dear EMS Providers,

We have always tried to be as current and up to date for all the emergencies that we know EMS makes a significant difference in.  We know getting a STEMI to an emergency cath lab saves heart muscle and lives.  We know that trauma patients need to go to trauma centers according to your regional trauma triage protocol.  We know EMS makes a lifesaving difference in anaphylactic shock, respiratory emergencies, and all category shock emergencies.  The state of Ohio as of June 22, 2021, required that all EMS, Fire, and transport services develop guidelines to care for stroke patients.  This is to include identifying large vessel occlusions.  We had invested a substantial amount of University Hospital’s resources in ASLS, (Advanced Stroke Life Support).  We trained trainers and placed the MEND exam into our regional protocol.  Unfortunately, we were now being tasked with utilizing a certified pre-hospital stroke exam that would screen for LVO.  We utilized our experts in the field.  Dr. Sila, who many of you have heard speak, was kind enough to help us make this transition.  Dr. Sila is the chair of our Neurology Department and Julie Fussner RN, Clinical Operations Manager.  In addition, we worked as partners with the Cleveland Clinic, Metro Health, and regional medical directors to establish a cohesive process that rapidly evaluates and properly dispositions our pre-hospital suspected stroke patients.  The result of everyone’s hard work was to utilize the VAN stroke assessment program in our pre-hospital setting.  All our medical control departments have been trained in the VAN.  We then had our EMR gurus Michael Monahan and Jonathan Cameron configure our Health EMS program to have a hard stop for inclusion of the VAN evaluation for all suspected stroke patients.  If you are on a different EMR please ensure that all providers are documented with the VAN.  This helps us identify possible LVOs prior to arrival and helps guide our imaging.  If you are using Health EMS, please do not reconfigure this process. 

Please excuse any redundancy, as I am aware that you have been well trained in our process, to evaluate possible stroke patients, and get them to the right place at the right time for the right care.  The following is our stroke evaluation in the pre-hospital setting.

1)      On scene: 

  A) Last known Well Information.

                B) Cincinnati Stroke Scale.

                C) Blood Glucose.

                D) Check for a radial pulse.

                E) Off the scene in under 10 minutes from arrival.

              2) In route: 

     A) VAN exam, (if the Cincinnati had no arm drift the VAN is listed as negative and does not have to be done).

                              B) Vitals in route.

                             C) Notify the hospital you are transporting to.

                              D) 12 lead only if time permits, (do not do this if it will cause a delay)

Below is a link to an excellent VAN 5-minute refresher video.


Don Spaner MD CMO EMS Institute.