I recently attended a CVA/TIA related call; it had been the first CVA related call I had been to since having a 4-year hiatus out of the trucks. Since being out the trucks the CVA consult/bypass protocol has been implemented. I’m having a difficult time understanding the point of the consult. If the Paramedic on scene is able to identify CVA symptoms accurately/appropriately, why are we delaying transport to discuss with a physician, who is not on scene, if we should transport to the appropriate stroke facility? It was explained to me that Paramedics weren’t correctly identifying CVAs pre-hospital. If that’s the case, those that aren’t recognizing a CVA aren’t performing a consult because they didn’t recognize the CVA in the first place. If I can identify a CVA correctly, announce a code stroke to dispatch, and have the stroke team ready on our arrival, how can there be any benefit to calling someone who knows nothing about the incident other than what I tell them? What is the difference between a doctor incorrectly identifying the CVA over the phone versus the Paramedic incorrectly identifying the CVA on scene other than the 15 minutes saved not trying to call for a consult? There also seems to be some significant discrepancies as to the onset of symptoms time frame between different receiving hospitals and physicians. Our destination guidelines clearly state within 6 hrs of onset of symptoms; however, recently a fellow medic advised me that it was 8 hrs but our guidelines have not yet been changed to reflect this, and a physician told me the window is 12 hrs. Any clarification/suggestions/info would be greatly appreciated. Thank you so much!