The increasing demands for emergent and primary care will strain the capacity of many EDs to provide even basic emergency care to acutely ill patients. To effectively incorporate preventive services into routine ED practice, a care- ful review of feasibility and cost-effectiveness is required of each intervention, again assuming that sufficient resources are Effective primary, secondary, and tertiary stroke prevention can occur in EDs, but significant healthcare organi- zational changes are required.926 These changes must address current limitations of health promotion training for healthcare providers, program funding, resource availability, and opportu- nities for timely referral for longitudinal care. Primary Prevention in the ED: Summary and Gaps The ED may serve as an important location to provide health promotion and disease prevention services, especially during these unique teachable moments, through screening, brief inter- vention, and referral for treatment. This opportunity to identify risk factors for stroke and to begin primary prevention requires further study into resource use, efficacy, effectiveness, and cost. Primary Prevention in the ED: Recommendations 1. ED-based smoking cessation programs and interven- tions are recommended (Class I; Level of Evidence B). 2. Identification of AF and evaluation for anticoagula- tion in the ED are recommended (Class I; Level of Evidence B). 3. ED population screening for hypertension is reason- able (Class IIa; Level of Evidence C). 4. When a patient is identified as having a drug or alco- hol abuse problem, ED referral to an appropriate therapeutic program is reasonable (Class IIa; Level of Evidence C). 5. The effectiveness of screening, brief intervention, and referral for treatment of diabetes mellitus and life- style stroke risk factors (obesity, alcohol/substance abuse, sedentary lifestyle) in the ED setting is not established (Class IIb; Level of Evidence C). 