Strokes are the third most common cause of mortality in western countries and the main cause of long-term invalidation. Systemic intravenous thrombolysis is the current therapeutical choice in acute stroke within 3 h after clinical onset but new pharmacological developments will have the potential to expand the time window for 6 h or more. To safeguard this option and for optimal treatment of stroke patients, better preclinical structures are necessary. A stroke is an extremely urgent case and emergency rescue services must treat this situation in a similar manner to polytrauma or cardiac arrest. Rescue services will need more training and knowledge in basic neurological examination and standard acute therapy, including maintaining sufficient oxidation of the brain, therapy of possible cardiac arrhythmias, blood pressure management, blood sugar disturbances and hyperthermia. Prior announcement of patients in the admitting hospital is desirable.