After diagnosis, emergency providers should arrange for rapid admission to a stroke unit or neuroscience intensive care unit (at their own hospital if available, or via transfer) and ini- tiate early management while the patient is awaiting this bed. A single-center study found that prolonged patient stays in the ED lead to worse outcomes, although another suggested that early neurocritical care management in the ED may ameliorate Although many centers have critical pathways developed for the treatment of acute ischemic stroke, few have protocols specific to the management of ICH.38 Such pathways may allow for more efficient, standardized, and integrated man- agement of patients with acute ICH; one is available from the Neurocritical Care Society.39 These pathways emphasize that urgent treatment of time-sensitive issues including BP lowering and reversal of coagulopathy should be initiated in the ED to which the patient presents rather than waiting until after transfer to an intensive care unit, stroke unit, or other hospital. Table 3. Class I Recommendations Section Class I Recommendations Emergency Diagnosis and Assessment A baseline severity score should be performed as part of the initial evaluation of patients with ICH (Class I; Level of Evidence B). (New recommendation) Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH (Class I; Level of Evidence A). (Unchanged from the previous guideline) Hemostasis and Coagulopathy, Antiplatelet Agents, and DVT Prophylaxis Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively (Class I; Level of Evidence C). (Unchanged from the previous guideline) Patients with ICH whose INR is elevated because of VKA should have their VKA withheld, receive therapy to replace vitamin K dependent factors and correct the INR, and receive intravenous vitamin K (Class I; Level of Evidence C). 