In an ideal world, a vascular neurologist excludes contraindications and starts treatment the minute a stroke occurs. While the first minute seems unrealizable, the first hour is not.1 Considerable time savings have been achieved with specialized stroke ambulances equipped with a computed tomography system and a neurologist on board.2,3 However, these specialized ambulances come at a certain cost, especially personnel costs.4,5 Can telemedicine replace the physical presence of a physician in a prehospital stroke setting?