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Time is brain: An online controlling of traffic lights can save lives
  1. Amin Amiri1,
  2. Reza Vafaeinezhad2,
  3. Mahmoud R Azarpazhooh1,3,4
  1. 1Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  2. 2Head of Emergency Medical Services (EMS), Mashhad University of Medical Sciences, Mashhad, Iran
  3. 3Department of Clinical Neurological Science, Western University, London, Ontario, Canada
  4. 4Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
  1. Correspondence to Professor Mahmoud R Azarpazhooh, Department of Clinical Neurological Science, University Hospital, London Health Science Center, Western University, London, ON N6A 3K7, Canada; azarpazhoohmr{at}

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Recently, we showed an extremely low rate of thrombolytic therapy in patients suffering acute ischaemic strokes in Mashhad, in Northeast Iran.1 During the 12-month study period (starting from September 2011), the overall rate of intravenous tissue plasminogen activator was 1.2% (n=1144 ischaemic strokes). The mean onset-to-needle and door-to-needle times were 172 and 58 min, respectively.1 A similar problem can be expected for other emergency conditions in our region, such as acute coronary disease, in which the time-to-needle duration is a life-saving criterion. Such a low rate of thrombolytic therapy can be explained in several ways—from patients’ health-seeking behaviours during the emergency conditions to prehospital/in-hospital infrastructures and facilities.1

Any delay in the golden minutes of emergency conditions, starting immediately after the …

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  • AA and RV are joint first authors.

  • Contributors All authors equally contributed to the study design, acquisition of data and writing the paper. AA was also responsible for the study analysis. RV and MRA were responsible for the critical revision of the manuscript for important intellectual content. MRA was involved in the study supervision.

  • Funding This research was funded by the Mashhad University of Medical Sciences.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Mashhad University of Medical Sciences.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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