Answer: This is a difficult and hopefully rare case! While CTAS 1 and uncorrected ABC problem would be contraindications to stroke bypass along with GCS < 10, it seems your patient improved to a GCS of 14 during your assessment.
The question really is (and we don’t know the answer) were these “episodes of recurrent syncope lasting 30min” a form of seizure such as non convulsive status or atonic seizures: types of seizures which can lead to a profound LOC and loss of postural tone with a gradual regaining of consciousness during the post ictal phase. These would also be contraindications to stroke bypass. Neuro findings are possible during post ictal phases. Other possibilities would include arrhythmia with LOC from hypoperfusion.
Your specific question we believe relates the occurrence with the hemiplegia which the bypass criteria (hemiplegia, accurate time of onset determination, transport within time limit, GCS of 14, no clear evidence of seizure and normal BS). As such, you would have been correct to follow the prompt card in this case related to that specific situation and patient assessment at that moment.
Our advice however when considering all of the background information regarding the frequent losses of consciousness would be (when considering all of the SWORBHP region) if confronted with rare cases like this in the future is to not engage in stroke bypass in general with patients who have recurrent episodes of syncope with GCS of 3. Under the bypass protocol, paramedics may be transporting up to 2 hours to the stroke centre. Quite possibly the case above could force paramedics to be on long transports with a patient with a significant airway problem (if the loss of consciousness were to return on transport) and ultimately stroke may not be their underlying diagnosis.
Remember, ED physicians in the closest hospitals can always secondarily activate the stroke bypass protocol if required and consider your local destination protocols which may include patching for such cases.