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Background: Advanced Practice Nurses from a community hospital provided education using a realistic stroke simulation scenario to local Emergency Medical Service (EMS) providers. EMS pre-hospital notification is one of the Target: Stroke best practice strategies. Rapid and accurate recognition of stroke in the pre-hospital setting is a key component of ensuring a stroke patient receives efficient and timely care.Purpose: To increase pre-hospital paramedic’s confidence in accurately identifying possible stroke patients using a simulation scenario.Methods: This was a program evaluation project. A stroke simulation scenario developed from an actual case was used to engage the paramedics in a realistic stroke scenario they could encounter in the pre-hospital setting. A standardized patient was used in the simulation scenario. A care confidence scale was used pre-simulation and post-simulation to evaluate each participant’s confidence in identifying stroke signs and symptoms, identifying the patient’s last known normal time, and performing the Cincinnati Prehospital Stroke Scale. An overall simulation evaluation was also completed by participants. Fifteen paramedics participated in the simulations.Results: There was increase in confidence in two out of the three measures. There was an overall 4.54% increase in the confidence of appropriately identifying stroke signs and symptoms. There was an overall 4.76% increase in the confidence in identifying the patient’s last known normal from pre-simulation to post-simulation. There was no difference in the confidence of assessing a patient using the Cincinnati Prehospital Stroke Scale. 15 simulation evaluations were completed. Each participant strongly agreed simulation was a valuable way to practice EMS skills and teamwork. Participants also strongly agreed they would like to see more simulation offerings in the future.Conclusions: Simulation is an effective intervention to increase paramedic’s confidence in identifying stroke signs and symptoms, and the patient’s last known normal time.