According to the American Heart and Stroke Association, 50% of people presenting to the emergency room with stroke symptoms arrive by private vehicle. Thrombolytic and interventional therapies offer significant clinical benefit, but require rapid prehospital stroke triage and delivery. The mode of transportation to the emergency department influences our ability to provide these therapies. Previous studies have identified factors that influence the utilization of 911 services. Information regarding ambulance service membership as a determinant for activating 911 is not well documented. Our 180 bed primary stroke center in rural Pennsylvania has been active in promoting community stroke education with an emphasis on activation of 911 at the onset of stroke symptoms. As part of our ongoing process improvement program, we found in 2014, 71% of stroke patients presented to our center by private vehicle. The purpose of this project is to determine the reasons for nonuse of 911 services including the role of ambulance service membership. Patient demographics were collected from Get With The Guidelines Stroke data base. We reviewed a sample population of 114 patients representing all those with a discharge diagnosis of stroke or transient ischemic attack from January to June 2015. A standard questionaire of 16 variables was utilized and patients were contacted by telephone or postal service. Of the 57 responses received, 22 (39%) arrived by ambulance of which 19 (86%) were members of a community ambulance service verses 35 (61%) arrived by private vehicle of which 17 (49%) were members of a community ambulance service. In conclusion, the results suggest that in a rural environment, membership in a community ambulance service appears to increase utilization of 911 services for prehospital stroke triage and transport, which may translate into earlier treatment and better outcomes. Our goal is to continue to monitor this data and modify our community stroke education efforts to include the potential value of ambulance membership in the treatment of acute stroke.