What is the Cincinnati Prehospital Stroke Scale (CPSS)?

A stroke (also known as a brain attack) is a medical emergency that occurs when the blood supply to the brain becomes disrupted. Most strokes occur due to a blood clot blocking one of the arteries in the brain. The brain cells become starved of blood and eventually die leading to catastrophic consequences.

Emergency treatment of a stroke may involve breaking up the blood clot by giving medication, or by mechanically removing the clot. This treatment needs to be started as soon as possible in order for the best chance of recovery.

Recognizing a stroke is occurring is vital to ensure emergency treatment can be given as soon as possible. The Cincinnati Prehospital Stroke Scale (CPSS) is a tool used by first responders in order to assess patients for a suspected stroke.

The Cincinnati Prehospital Stroke Scale looks for three specific symptoms which may be suggestive of a stroke:

  1. Facial droop
  2. Arm drift
  3. Slurred or abnormal speach

Facial droop

Ask the patient to smile. Normally, both sides of the face should move equally. Facial droop occurs when one side of the face does not move.

An example of facial droop

Arm drift

Ask the patient to raise both of their arms, close their eyes and keep their arms raised for 10 seconds. Normally, both arms should remain elevated.

Arm drift occurs when one arm does not move, or drifts downwards.


Ask the patient to say a standard phrase, such as “you can’t teach an old dog new tricks.”

If there is any slurring of speech, or the patient uses inappropriate words or is unable to speak then this is abnormal speech.

Interpretation of the CPSS

If any of the features above are present (facial droop, arm drift or abnormal speech) then a stroke should be suspected. Emergency medical help should be called for as soon as possible and the patient transferred to a stroke centre.

The CPSS is very similar to the FAST test which looks for facial droop, arm weakness and slurred speech.

The FAST test is similar to the CPSS

John Furst

JOHN FURST is an experienced emergency medical technician and qualified first aid and CPR instructor. John is passionate about first aid and believes everyone should have the skills and confidence to take action in an emergency situation.

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