Consultants should be contacted as quickly as pos- sible while the patient is in the ED, and the clinical evaluation should be performed efficiently, with physicians and nurses working in parallel. Consultation via telemedicine can be a valuable tool for hospitals without on-site presence of consul- Table 4 describes the integral components of the his- tory, physical examination, and diagnostic studies that should be obtained in the ED. A routine part of the evaluation should include a stan- dardized severity score, because such scales can help stream- line assessment and communication between providers. The National Institutes of Health Stroke Scale (NIHSS) score, commonly used for ischemic stroke, may also be useful in However, ICH patients more often have depressed consciousness on initial presentation, and this may diminish the utility of the NIHSS. Numerous grading scales exist spe- cifically for ICH.26 32 Although the optimal severity scale is not yet clear, the most widely used and externally validated is the ICH Score.28,30,33 35 These severity scales should not be used as a singular indicator of prognosis. 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. 