Recombinant tissue plasminogen activator(rt-PA) was approved by the FDA in 1996 for the treatment of acuteischemic stroke. Despite its proven efficacy, however, rt-PAtherapy has not been widely used among ischemic stroke patients.Studies have estimated that only 1.8% to 3.0% of all ischemicstroke patients in the United States are treated with rt-PA; theupper end of that range was not achieved until FY 2007. There aremany reasons why rt-PA is not administered to more stroke patients,the most important of which is prehospital delays in presentation.Within the US population, only 8% of ischemic stroke patientspresent to an emergency department eligible for rt-PA. In addition,several important systems issues regarding the hospital ofpresentation affect whether a patient receives rt-PA, such asprotocols for acute stroke patient triaging, stroke education forlocal EMS and ED staff, and 24-hour CT availability.