Endovascular therapy has revolutionized treatment of acute stroke with large vessel occlusion (LVO), but only a small minority of hospitals offer this life-saving treatment, so the vast majority of patients rely on inter-facility transfer. The treatment benefit is time dependent, so there is a clear need for EMS providers to detect LVO during the prehospital evaluation, which will afford the opportunity to route patients direct to endovascular-capable centers and thereby reduce treatment times, post-stroke disability, and associated healthcare costs. Our group has leveraged a novel non-invasive optical imaging modality that quantifies cerebral blood flow to quickly and easily detect LVO in order to optimize prehospital stroke care.