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“The management of patients who suffered a stroke, or „brain attack‟, has historically been very poor. The expectation was that this was a group of patients, mostly elderly, with a condition for which the outcome was often poor and for which little effective management was available. In contrast, the London Ambulance Service NHS Trust (LAS) has, over the past decade, led the way in improving survival for patients who have suffered a „heart attack ‟ or out of hospital cardiac arrest. The standards we have set in this area have driven up the expectations of not only patients, the public but other ambulance services both nationally and internationally. It is therefore with great pride that we publish the first annual report into the care given to our stroke patients. This report, as highlighted by Professor Rudd‟s comments below, demonstrates that as in cardiac care, the LAS has been instrumental in working in partnership to deliver a service which has dramatically influenced the standard of care available to the many patients across London who have suffered a stroke. We have demonstrated that the LAS is able to accurately identify patients who have suffered a stroke, prioritise those for whom clot busting treatment is an option, and ensure the most appropriate triage decision is made for all these patients. We have worked closely with the Stroke Networks and with individual hospitals to improve the response to this group of patients. This report not only identifies those areas where we have made great progress but also identifies where we can improve our response, to ensure an even faster referral, accepting the especially challenging nature of some of these calls.