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Background: Following the results of randomized clinical trials supporting the use of mechanical thrombectomy (MT) with tPA for large vessel occlusion (LVO) stroke, our state Stroke Task Force convened to 1) update legislation to recognize differences between Primary Stroke Centers (PSCs) and Comprehensive Stroke Centers (CSCs) and (2) update EMS protocols to triage direct transport of suspected LVO patients to CSCs.Objectives: Develop an assessment and single-session training curriculum to assess EMS knowledge before and knowledge gained after training on Los Angeles Motor Scale (LAMS) score, its use to correctly triage patients as CSC-appropriate, and our state-wide EMS protocol for stroke. We also aim to share our specific approach and its efficacy with others so our work can be disseminated and implemented elsewhere.Methods: We assembled a focus group to develop assessment questions that would mimic real-life conditions EMS personnel operate under. Ten identical pre-post training questions were formulated to assess content provided during the trainings. Content validity was established by ensuring that questions exclusively tested the content of the slides in the training.Results: Trainings were provided for 354 EMS professionals throughout the state. Average pre-test score was 52.4% (95% CI 49%-56%). Average post-test score was 85.6% (83%-88%), representing a significant increase. Each of the 10 questions were individually assessed and all showed significant gains in EMS knowledge after training (Figure 1, p<0.0001).Conclusions: Structured EMS education can improve knowledge of stroke triage protocols. As EMS protocols are changed to improve triage of suspected LVO patients to CSCs, such educational efforts will be critical to improve compliance.