A stroke occurs when a blood vessel in the brain becomes occluded or ruptures, resulting in paralysis or death of the patient. There are approximately 800,000 strokes a year, resulting in 50% of large vessel occlusions. The importance of early recognition of large vessel occlusion strokes is that these strokes result in the most severe causes of death and disability. SAH or subarachnoid hemorrhage is a life-threating emergency that has a 50% mortality if not recognized early. Early detection is imperative in the prehospital setting. Polk County Fire Rescue has developed a tool that accurately screened all SAH and  LVO patients 90% of the time, resulting in only 10% transfers to comprehensive stroke centers. This has been augmented using a regional stroke triage system using local ED physicians and the App Pulsara to accurately diagnose and treat LVO and SAH patients.