Recently proposed JC CSC designation will help identify centers with exceptional capabilities for care of ischemic and hemorrhagic stroke patients. Designating these centers allows EMS to triage stroke patients appropriately. Criteria for CSCs must be tailored to select hospitals most capable of serving a given population, keeping in mind the practical issues of ground transport to CSCs. The designation process should ideally encourage hospitals to achieve and maintain high standards in comprehensive stroke care while providing a practical system of healthcare delivery. To this end, continued involvement of governing agencies in the CSC process may be an important ingredient for the system's success.