Inclusion Criteria:  Patients entered into the Alabama stroke system by EMS Suspected Large-Vessel Occlusion (score ≥ 4) based on a validated 6 item stroke severity scale, the Emergency Medical Stroke Assessment (EMSA)  Exclusion Criteria:  Patients who respond only to pain or who are unresponsive at the time of EMS evaluation based on the Alert, responds to Voice, responds to Pain and Unresponsive (AVPU) Scale Patients with last known well time > 24 hours at the time of EMS evaluation