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Stroke, heart attack and sepsis: the conditions with a clock
The three emergencies where the treatment that works expires, the signs that should end the discussion, and why the ambulance beats the car even when the car is faster.
This page explains how the system works. It is not a diagnosis, it cannot tell you how urgent your own situation is, and it is not a directory: it carries no clinic addresses, opening hours or visiting times, because those change and a wrong one sends you to a closed door. If someone may be seriously ill or injured, call the emergency number — 112 across the region, 113 for medical emergencies in Norway — and if you are unsure, call your country’s advice line rather than deciding from a web page.
Stroke: the clock starts when the symptoms did
The test is FAST. Face — has one side dropped, can they smile evenly. Arms — can they lift both and keep them up. Speech — is it slurred, are the words wrong, can they repeat a sentence. Time — call the emergency number now, and note when the person was last seen definitely well. That last fact is the single most valuable thing a bystander can supply, because the treatment options are defined by it: intravenous clot-busting treatment is given within about four and a half hours of symptom onset, and mechanical clot retrieval extends the window further, up to twenty-four hours in carefully selected patients on the basis of imaging. Someone who wakes with symptoms is assessed against when they went to bed. Do not wait to see whether it passes; a stroke that resolves in minutes is a transient ischaemic attack and is itself an emergency, because it is often the warning before the large one.
Heart attack: do not drive yourself
Central chest pain or pressure lasting more than a few minutes, often with sweating, nausea, breathlessness or pain spreading to the arm, jaw or back, is an emergency call. Presentation is less classical in women, in people with diabetes and in the elderly, where breathlessness, unusual fatigue or upper abdominal discomfort may be all there is. Guideline care requires an ECG within ten minutes of first medical contact and, for the type of heart attack that shows on it, reopening the artery as fast as the network allows. The ambulance is what makes that possible: the crew records the ECG in the vehicle, transmits it ahead, and can take the patient past the emergency department directly to the catheterisation laboratory. A private car cannot do any of that, and someone having a heart attack must not be the one driving.
Sepsis: the one people miss
Sepsis is the body’s response to an infection turning against its own organs, and it kills through delay more than through virulence. Suspect it when an infection — a chest, urine, skin, abdominal or post-operative infection — comes with any of the following: very fast breathing, a fast heart rate, confusion or unusual drowsiness, a temperature that is very high or abnormally low, mottled or grey skin, not passing urine for many hours, or a feeling in the patient of being about to die. In a child add the non-blanching rash, the cold hands and feet with a hot body, and the baby who will not feed or is unusually floppy. Treatment is time-dependent in the same way as the other two: guideline care puts antibiotics inside the first hour of recognition, and every hour of delay counts against survival. Say the word at the door — "I am worried about sepsis" is a phrase emergency departments act on.
Anaphylaxis and major trauma
Two more that beat every queue. Anaphylaxis — swelling of the lips, tongue or throat, a hoarse voice, wheeze or sudden difficulty breathing, collapse, or widespread hives with any of those — is treated with intramuscular adrenaline first and a call second, in that order if an auto-injector is available, and the person should lie flat rather than stand up. Major trauma with a mechanism that could break a spine or an internal organ is an ambulance call even if the patient feels fine, because internal bleeding announces itself late. In both cases the destination matters: crews take major trauma to a hospital with the surgical and imaging cover for it rather than to the nearest building with a red cross on it.
Why the ambulance is faster than the car
It looks obvious that a car with a clear road is quicker than waiting for a vehicle to arrive, and for the door-to-door distance it sometimes is. It is still the wrong choice, for four reasons that have nothing to do with speed. The crew begins treatment at the patient’s side, minutes before any car could start moving. They carry oxygen, monitoring, drugs and a defibrillator. They choose the destination on clinical grounds — the stroke unit, the catheterisation laboratory, the trauma centre — which may not be the nearest hospital. And they announce the patient, so the team is assembled and the scanner is free on arrival rather than an hour later. The hospital levels page explains why the nearest hospital is so often the wrong one for exactly these conditions.
Sources: The FAST test and the stroke treatment windows follow international stroke guidance; the 4.5-hour thrombolysis window and thrombectomy up to 24 hours in selected patients are the standard figures · The 10-minute first ECG target follows international guidance on acute coronary syndromes · The antibiotics-within-the-hour target follows the Surviving Sepsis Campaign guidance · checked 2026-09-08
Frequently asked questions
What is the FAST test?
Face, Arms, Speech, Time. Has one side of the face dropped; can both arms be raised and held up; is speech slurred or wrong; and if any of those is true, call the emergency number immediately and note when the person was last seen well. That last time defines which treatments are still available.
How long is the window for stroke treatment?
Intravenous clot-busting treatment is given within about four and a half hours of symptom onset. Mechanical removal of the clot extends the window considerably further — up to twenty-four hours in carefully selected patients chosen on imaging — but eligibility narrows with every hour, which is why the time of onset is the critical fact.
What are the signs of sepsis?
An infection plus any of: very fast breathing, a fast heart rate, confusion or unusual drowsiness, a very high or abnormally low temperature, mottled or grey skin, passing no urine for many hours, or a sense of impending doom. In children also a non-blanching rash, cold hands and feet with a hot body, or a baby who will not feed or is floppy. Treat it as an emergency and say the word at the door.
Should I take aspirin for chest pain?
That is a decision for the emergency call handler or the crew, who will tell you what to do and what not to. Call first and follow the instruction you are given rather than acting on a general rule, because it depends on the person and on what else they take.
Can I drive someone to hospital with chest pain?
No, and they must certainly not drive themselves. The ambulance records and transmits the ECG on the way, carries the drugs and the defibrillator, and can take the patient straight to the catheterisation laboratory past the emergency department. A car does none of that, and a cardiac arrest in a moving car is close to unsurvivable.
Related pages
Emergency department, out-of-hours or your own doctor?
Five doors into the same health service, what each is actually for, and the two questions that pick the right one in about ten seconds.
How the emergency department decides who goes first
The five-level ladder, the target times that go with each colour, why arrival order is irrelevant, and what to do when you get worse in the waiting room.
Calling an ambulance: what the dispatcher asks, and why
The questions in the order they come, why you must not hang up, what to do in the minutes before the crew arrives, and when they will send something other than an ambulance.
Which emergency department for a child
Where the paediatric emergency care actually is in this region, the age rules that override everything, and the signs that make a child’s illness a same-hour problem.
How published waiting-list figures actually work
Two completely different numbers get called "the waiting time", the published figure is almost never yours, and there are four things that genuinely shorten a wait.
Every country, every number
The hub: emergency and advice numbers for the whole region, the access rules and all the country pages.
The four questions a hospital always asks
Age, weight, what you take and when it started. TempoLife keeps the medicine log, the symptom timeline and the measurements in one place, so the answers exist before anyone asks for them.