EMS Assessment and Management COR LOE New, Revised, or Unchanged The use of a stroke assessment tool by first aid providers, including EMS dispatch personnel, is recommended. I B-NR Recommendation reworded for clarity from 2015 CPR/ECC. COR and LOE unchanged. See Table XCV in online Data Supplement 1 for original wording. In 1 study, the positive predictive value for a hospital discharge diagnosis of stroke/transient ischemic attack (TIA) among 900 cases for which EMS dispatch suspected stroke was 51% (95% CI, 47 54), and the positive predictive value for ambulance personnel impression of stroke was 58% (95% CI, 52 64).23 In another study of 21760 dispatches for stroke, the positive predictive value of the dispatch stroke/TIA symptoms identification was 34.3% In both cases, use of a prehospital tool for stroke screening improved stroke identification, but better stroke identification tools are needed in the prehospital setting. See Table I in online Data Supplement 1. EMS personnel should provide prehospital notification to the receiving hospital that a suspected stroke patient is en route so that the appropriate hospital resources may be mobilized before patient arrival. I B-NR Recommendation reworded for clarity from 2013 AIS Guidelines. COR unchanged. LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. In the AHA Get With The Guidelines (GWTG) registry, EMS personnel provided prearrival notification to the destination ED for 67% of transported stroke patients. EMS prenotification was associated with increased likelihood of alteplase treatment within 3 hours (82.8% versus 79.2%), shorter door-to-imaging times (26 minutes versus 31 minutes), shorter DTN times (78 minutes versus 80 minutes), and shorter symptom onset-to-needle times (141 minutes versus See Table I in online Data Supplement 1. 1.1. 