Unfortunately, up to 69% of acute stroke patients are unable to get recombinant tissue plasminogen activator (r-tPA) secondary to delay in patient arrival, spurring initiatives to deliver stroke care as quickly as possible. The largest, and most important, window for reducing delays to treatment is prior to hospital arrival. In the prospective ‘Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke’ (PHANTOM-S) study, which compared conventional care to pre-hospital thrombolysis with r-tPA with an in-field emergency-trained vascular neurologist, significantly more patients received r-tPA in the pre-hospital thrombolysis arm of the study versus conventional care (31% versus 4.9%, PP<0.001) (see {1}). If resources allow, a mobile stroke unit is able to deliver acute stroke care with the least amount of delay. However, this cost-effectiveness analysis of the PHANTOM-S study showed that this comes at a very large financial cost (e.g. initial outfitting of the ambulance and subsequent maintenance), which may be an obstacle for implementation within many healthcare systems.