Activation of the 9-1-1 system by patients or other members of the public is strongly recommended. 9-1-1 dispatchers should make stroke a priority dispatch, and transport times should be minimized. I B-NR Recommendation and COR unchanged from 2013 AIS Guidelines. LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. EMS use by stroke patients has been independently associated with earlier ED arrival (onset-to-door time 3 hours; adjusted odds ratio [OR], 2.00 [95% CI, 1.93 2.08]), quicker ED evaluation (more patients with door-to-imaging time 25 minutes; OR, 1.89 [95% CI, 1.78 2.00]), more rapid treatment (more patients with door-to-needle [DTN] time 60 minutes; OR, 1.44 [95% CI, 1.28 1.63]), and more eligible patients being treated with alteplase if onset is yet only 60% of all stroke patients use EMS.22 Men, blacks, and Hispanics are less likely to use EMS.20,22 Thus, persistent efforts to ensure activation of the 9-1-1 or similar emergency system by patients or other members of the public in the case of a suspected stroke are warranted. See Table I in online Data Supplement 1. 1.3. EMS Systems 1.3. EMS Systems COR LOE New, Revised, or Unchanged Regional systems of stroke care should be developed. These should consist of the following: (a) healthcare facilities that provide initial emergency care, including administration of IV alteplase, and (b) centers capable of performing endovascular stroke treatment with comprehensive periprocedural care to which rapid transport can be arranged when appropriate. I A Recommendation reworded for clarity from 2015 Endovascular. COR and LOE unchanged. See Table XCV in online Data Supplement 1 for original wording. 