Mission: Lifeline® Stroke

Severity-Based Stroke Triage Algorithm for EMS

Mission: Lifeline Stroke is a program for transforming stroke care by focusing efforts on connecting all of the components of acute stroke care into a smoothly integrated system that reinforces use of evidence-based guidelines, measures performance, identifies gaps, and engages in improvement projects at a systems level. The stroke system of care begins with community recognition and preparedness to identify stroke and continues all the way through hospital discharge, into rehabilitation and the initiation of secondary prevention. It brings together hospitals, ambulance services, non-transport medical first response agencies, emergency communications centers, emergency medical service regulatory and medical direction agencies, local government, local media, and payers to forge a proactive system of stroke care that saves and improves lives.

The American Heart Association and American Stroke Association (AHA/ASA) requested that its Mission: Lifeline Stroke Committee craft a consensus algorithm that was subsequently reviewed by numerous stroke committees within the organization. This algorithm seeks to balance the benefits of rapid, early access to EVT for patients with suspected LVO with the potential harm of delayed initiation of IV alteplase.

A thorough review of current guidelines and studies was conducted to help develop the algorithm. As with any algorithm, it should augment but not replace clinician judgment and may need tailoring to address the needs of the communities that implement it.

Mission: Lifeline Stroke is excited to announce the release of the Severity-based Stroke Triage Algorithm for EMS and a one page document explaining the algorithm. Click the links below to view the Algorithm and supporting document.


  • About the Severity-based Stroke Triage Algorithm for EMS- One Pager 2020 (PDF)
  • Severity-based Stroke Triage Algorithm for EMS 2020 (PDF)
  • Program Leadership

    Co-Chairs: Drs. Peter Panagos and Lee Schwamm

    Peter Panagos, MD (Co-Chair) - Dr. Panagos is an Associate Professor of Emergency Medicine and Neurology at Washington University in St Louis. He is a 1987 graduate of Dartmouth College. In 1994, he completed his medical education at Emory University. Following a year of surgical training at Naval Medical Center San Diego, he graduated and received his wings as a Naval Flight Surgeon in Pensacola, Florida. From 1996-1999, he was stationed in Okinawa, Japan from with the 1st Marine Aircraft Wing. In 2002, he completed a residency in Emergency Medicine at the University of Cincinnati and subsequently completed a SAEM funded Neurovascular Emergencies/Stroke Fellowship at the same institution in 2003. This was a first for an emergency physician in the US. Dr. Panagos’ primary research and clinical interest is the acute stroke management. He has published over 100 articles and abstracts and has lectured over 350 times across the US and worldwide, mainly on the topic of stroke care.

    Lee Schwamm, MD (Co-Chair) – Dr. Schwamm is Professor of Neurology at Harvard Medical School, and Vice Chairman of Neurology at the Massachusetts General Hospital, where he is the Director of Acute Stroke Services. He also acts as Director of the Partners TeleStroke Center, a network which currently provides acute stroke consultation services to 27 rural and community hospitals in Massachusetts and Northern New England. His clinical interests are in Cerebrovascular Diseases, Intensive Care Medicine, Brain Imaging and Applied Healthcare Technology. Dr. Schwamm is a recognized leader in the field on the acute stroke treatment, stroke advocacy, and in the use of telemedicine and other technology strategies to improve the quality of stroke care. He has played a pivotal role in the development and leadership of the American Heart Association's National Get With the Guidelines-Stroke program, and is currently chair of the national steering committee. He also serves as a consultant or technical expert to the Massachusetts Dept of Public Health, the CDC's Paul Coverdell National Acute Stroke Registry, the Joint Commission Primary Stroke Center program, National Quality Forum and Canadian Stroke Registry.

    Staff Lead: James Lugtu ([email protected])