In 2015, planning began with the support of hospital administration, community leaders, surrounding stroke centers, local EMS/Fire agencies, and clinical research entities. Support was garnered politically from local government officials and financially from philanthropic donations. To maintain compliance with the established county stroke triage/transport algorithm, a protocol was developed to integrate MSU dispatch into the public communications 911 system. This facilitated the step-wise participation of local hospitals. In July 2018, the training phase began, which included mock runs, interfacing with EMS/Fire departments, and creating electronic order sets ensuring efficient and safe handoffs in the Emergency Department. In December 2018, a run-in phase began during which patients were transported and treated on the MSU and workflows were iterated. In March 2019, the MSU began enrolling in the national multi-site BEST-MSU clinical trial as the only participating Community Hospital site.