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Introduction: Delays in recognizing stroke during pre-hospital emergency medical system (EMS) care may affect triage+transport time to appropriate stroke ready hospitals and may preclude patients from receiving time dependent treatment. All EMS transports in a large urban area in the stroke belt were evaluated for transport destinations, triage+transport time and stroke recognition following distribution of an educational training video to local EMS services.Hypothesis: Following video training local paramedics will improve stroke recognition, shorten triage+transport time, and increase stroke transports to primary stroke centers (PSC) of care.Methods: A training module (<10 min) containing a stroke scene scenario, instruction on the Cincinnati Prehospital Stroke Score (CPSS) and the Los Angeles Prehospital Stroke Score (LAPSS) and ‘where to transport’ stroke patients was distributed and viewed by 94 paramedics. Data was collected from February to October 2016. Stroke recognition was determined from one PSC hospital’s confirmation of EMS delivered patients (site A). Stroke recognition percentages from site A collected in 2014 were used as baseline.Results: A total of 35,207 emergency 911 response transports were made with a total of 506 (1.4%) paramedic identified strokes. Average triage+transport time for stroke transports was 33 +/- 0.7 minutes. The PSC hospitals received a 5% increase in stroke transports and the non-specific care facilities decreased by 7%. The PSC stroke confirmation totaled 130 transports with 140 suspected strokes by paramedics and 71 of 130 confirmed strokes correctly identified by paramedics (positive predictive value of 50.7%, sensitivity of 54.6%). By the third month following training, recognition percentages increased from 54% at baseline to 73%. At five months, percentages of correct stroke identification had dropped to pre-training levels.Conclusion: The training improved stroke recognition by an additional 19% with follow-up training recommended at five months.