The past decade’s success with thrombolysis for ischemic stroke has generated intense interest, despite the risk of intracranial hemorrhage. Stroke centers and rapid treatment protocols have become a new focus of emergency medicine, although risk-factor reduction deserves greater emphasis. This article details the development of a stroke center, protocols, and medical-legal issues. A patient case is used to visibly explain how improved outcome can result from reducing a few minutes at every step in the three-hour window to thrombolysis.