See Table XCV in online Data Supplement 1 for original wording. EMS leaders, in coordination with local, regional, and state agencies and in consultation with medical authorities and local experts, should develop triage paradigms and protocols to ensure that patients with a known or suspected stroke are rapidly identified and assessed by use of a validated and standardized tool for stroke screening. I B-NR Recommendation reworded for clarity from 2013 Stroke Systems of Care. COR and LOE added to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. Multiple stroke screening tools have been developed for prehospital evaluation of suspected stroke. A 2016 systematic review assessed the performance of 7 tools.26 Those with the highest number of subjects in whom the tool had been applied included Cincinnati Prehospital Stroke Scale (CPSS),27 Los Angeles Prehospital Stroke Screen Recognition of Stroke in the Emergency Room (ROSIER),29 and FAST (Face, Arm, Speech, Time).30 CPSS and FAST performed similarly with regard to sensitivity (range, 44% 95% for CPSS, 79% 97% for FAST) but both had poor specificity (range, 24% 79% for CPSS, 13% 88% for FAST). More complex tools such as LAPSS had improved specificity (range, 48% 97%) but at the cost of sensitivity (range, 59% 91%). All tools inadequately accounted for false-negative cases, thereby likely artificially boosting performance. The review concluded that no strong recommendation could be made for use of one tool over another. See Tables III and IV in online Data Supplement 1. Patients with a positive stroke screen or who are strongly suspected to have a stroke should be transported rapidly to the closest healthcare facilities that are able to administer IV alteplase. I B-NR Recommendation reworded for clarity from 2013 AIS Guidelines. 