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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.

Cette page explique comment le système fonctionne. Ce n’est pas un diagnostic, elle ne peut pas dire à quel point votre situation est urgente, et ce n’est pas un annuaire : elle ne porte ni adresses de cliniques, ni horaires, ni heures de visite, parce que ça change et qu’un faux envoie à une porte fermée. Si quelqu’un peut être gravement malade ou blessé, appelez le numéro d’urgence — 112 dans la région, 113 pour les urgences médicales en Norvège — et si vous n’êtes pas sûr, appelez la ligne de conseil de votre pays plutôt que de décider depuis une page web.

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· vérifié2026-09-08

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