Background:
Canadian Stroke Best Practice Recommendations states that approximately two-thirds of all patients who seek acute care for stroke in Canada arrive at the Emergency Department by Ambulance. The current target for transport to hospital by paramedics is 80% of cases. In Northwestern Ontario (NWO), only 49% of all patients who seek stroke acute care arrive at the Emergency Department by ambulance with the Ontario provincial average being 64.8%. NWO communities are spread across 458,010 kilometers. Residents need to know the urgency of stroke care, understand that time lost is brain lost and that the paramedics play a key role in the critical first hours of stroke care. 

Methods:
Since 2015, the Northwestern Ontario Regional Stroke Network (NWORSN) and EMS collaborate and partner to build awareness, increase knowledge and helps save lives of stroke in NWO. Projects include Advanced Stroke Education at the EMS training sessions; First Responder teams trained in Stroke Education; EMS and Stroke Neurologist Question and Answer You Tube video produced. FAST decals project in partnership with Heart and Stroke Foundation. 

Results:
Stroke Education to EMS trained 190 paramedics. 12 first responder teams provided training, totally 113 first responders.  You Tube video provided to 4 EMS services for staff education. All 4 EMS services received FAST decals, totally 77 ambulances. 

Conclusions:
The NWORSN has strong partnerships with EMS resulting in improved access to EMS for stroke patients, increased knowledge for paramedics and first responders and continued collaboration and coordination of system optimization and stroke care.

Collaboration and Partnerships with EMS to enhance the stroke system in Northwestern Ontario.