Abstract Prehospital delays in the treatment of stroke patients, including identification of stroke as a medical emergency, represent a significant and preventable obstacle to optimal stroke care. Although patient delay in seeking care represents the greatest barrier to expedient care, delays often exist in the identification, transport, and triage of stroke patients. Public education in recognizing stroke symptoms as warranting immediate care and appropriate training of emergency medical service personnel are essential parts of community-wide, coordinated stroke care. In addition, emergency physicians must be engaged in the effort to limit delays if the rates of patients eligible for thrombolytic therapy are to improve. This review presents the common inadequacies in the prehospital identification and care for stroke patients and discusses changes within the community health care system that can be implemented to improve the critical early stages of stroke management.