We propose to conduct a rigorous evaluation of the revised Acute Stroke Medical Redirect Paramedic Protocol (ASMRPP). We expect to prospectively evaluate the ASMRPP on a prospective cohort of 2,400 patients with possible stroke, including 800 who are redirected from remote, rural, and urban communities to the three stroke centres. We will compare outcomes to those of a 2009 retrospective cohort obtained from the Canadian Stroke Registry.