Intro: 2024 GWTG data shows low rates of stroke screening (31%), severity tool performance (18%), and prehospital notification (52%) in Texas. To assess current practices, the Texas Governor’s EMS and Trauma Advisory Council, in collaboration with the Dept of State Health Services (DSHS), conducted a statewide EMS survey. Methods: A REDCap survey was distributed statewide (Oct 2024–Jan 2025) via DSHS email lists for registered EMS providers, assessing practice setting, documentation, stroke screening tool utilization, confidence, training, and pre-notification. Results: Of 189 respondents, 147 (78%) completed and 42 (22%) partially completed the survey. Respondents included paramedics (73%), EMTs (9%), RNs (9%), AEMTs (6%), and EMS medical directors (7%); 71% reported leadership roles. Practice settings were rural (44%), urban (28%),&suburban (28%), spanning 14/22 Trauma Service Areas (29% from TSA-E). Most reported using electronic patient care record (96%). Stroke screening: 152 (98%) reported being instructed to use a tool. The most frequently cited were CPSS (86%) and FAST (43%). Performance confidence was high: very confident (58%), confident (36%), somewhat confident (5%), not confident (2%). Training occurred yearly (40%), more than once yearly (27%), or less often (33%). Stroke screening was reported as performed in >75% of suspected cases by (68%), with smaller proportions reporting less consistent use. LVO screening adoption was less widespread. 104 (68%) were instructed to use an LVO tool. Most common tools included VAN (51%), C-STAT (19%). Confidence was lower than standard screening: very confident (47%), confident (35%), somewhat confident (18%), and not confident (1). Training was annual (43%) or more frequent (25%), but 11 reported only one exposure or no training. In practice, 51% reported LVO tools used in >75% of suspected cases, but 21% used them 75% reported by 80%. Documentation was via structured fields (59%) or narrative notes (41%). Leadership and non-leadership respondents reported similar overall tool use and pre-arrival notification rates. Conclusions: Texas EMS providers report utilizing prehospital stroke screening. Confidence is high, and hospital pre-notification is reported as consistently practiced. However, variability in training and documentation persists. LVO tool adoption is moderate, with lower confidence, less frequent training, and less use.
Pervez et al. (2026) studied this question.