The PSC ELVO protocol workflow is focused on early notification of the comprehensive stroke center (CSC; with a goal of <30 minutes), obtaining early vessel imaging (with a goal of <30 minutes) at the PSC, and cloud-based image sharing. CTA indicates computed tomographic angiography of the brain and neck; CT, computed tomography of the brain; EMS, emergency medical services; and IV tPA, intravenous tissue plasminogen activator (alteplase).