If someone near you is having a stroke, the single most important thing you can do is call 911 immediately. Every minute without treatment costs roughly 1.9 million brain cells, and the treatments that can reverse a stroke are only available at a hospital within strict time windows. Your role as a bystander is to recognize the emergency, make the call, keep the person safe, and gather information that paramedics will need.
Recognize the Signs With BE FAST
The American Stroke Association uses the acronym BE FAST to help bystanders spot a stroke quickly:
- Balance: Sudden loss of balance or coordination, trouble walking
- Eyes: Blurred or double vision, or loss of vision in one or both eyes
- Face: One side of the face droops when the person tries to smile
- Arm: One arm drifts downward when they try to raise both arms
- Speech: Slurred or garbled words, or inability to repeat a simple sentence
- Time: Call 911 right away
You don’t need to see all of these signs. Even one is enough to act on. And if the symptoms seem to go away after a few minutes, call anyway. A transient ischemic attack (sometimes called a mini-stroke) produces the same symptoms but resolves on its own. It is still a medical emergency because it can precede a full stroke, and there’s no way to tell the difference in the moment.
What to Do While Waiting for Help
Once you’ve called 911, your job shifts to keeping the person as safe and comfortable as possible. Current guidelines recommend that stroke patients lie flat, but if the person is having trouble breathing, is vomiting, or appears to be choking, raise their head and shoulders slightly. If they’re unconscious and breathing, gently roll them onto their side to keep their airway clear.
Stay with the person and keep them calm. Don’t let them get up and walk around, even if they insist they feel fine. Loosen any tight clothing around the neck or chest. Note the time you first noticed symptoms, or better yet, the last time you saw them acting completely normal. This “last known well” time is critical for hospital decision-making. One study found that when the last known well time was recorded inaccurately, 58% of patients would have been treated outside the approved window for clot-dissolving medication, putting them at higher risk of complications.
What Not to Do
Do not give the person aspirin. While aspirin can help during a heart attack, about 15% of strokes are caused by bleeding in the brain rather than a clot. Aspirin thins the blood, which would make a bleeding stroke dramatically worse. Since you can’t tell which type of stroke someone is having, aspirin is a gamble that doctors at the hospital are better equipped to make.
Do not give food or water. A stroke often impairs the ability to swallow, and anything taken by mouth could end up in the lungs. Medical guidelines also recommend against trying to lower someone’s blood pressure before they reach the hospital. The European Stroke Organization specifically advises against routine blood pressure lowering in the prehospital setting for suspected stroke patients. In short, focus on comfort, safety, and getting them to a hospital fast.
Information Paramedics Will Need
When EMTs arrive, they’ll ask you questions that directly affect treatment decisions. The most important piece of information is the last time the person was known to be well, not when symptoms started. If you saw them walking and talking normally at 2:00 p.m. and found them with slurred speech at 2:30 p.m., the “last known well” time is 2:00 p.m. This timestamp determines whether the patient qualifies for time-sensitive treatments like clot-dissolving drugs (available roughly within 3 to 4.5 hours) or clot-removal procedures.
If you can, also gather the person’s medications, or take a quick photo of their pill bottles. Know their name, age, and any medical conditions you’re aware of. If they take blood thinners, that’s especially important to mention. All of this saves precious minutes at the hospital.
Why Minutes Matter So Much
Stroke treatment is extremely time-dependent. The clot-dissolving medication used for the most common type of stroke works best when given early, and its approved window closes within hours. A mechanical procedure to physically remove larger clots can extend that window further for some patients, but eligibility still depends on how much time has passed and how much brain tissue remains salvageable. Every delay narrows the options available to the medical team.
This is also why you should always call 911 rather than driving the person to the hospital yourself. Paramedics can begin assessment in the ambulance, alert the hospital to prepare the stroke team, and route to a certified stroke center rather than the nearest emergency room. That head start can shave 30 minutes or more off the time to treatment.
Supporting Recovery After the Emergency
Stroke is a leading cause of serious long-term disability, and recovery doesn’t end when someone leaves the hospital. If you’re a family member or close friend, your role during rehabilitation can meaningfully affect outcomes. The brain has a remarkable ability to rewire itself after injury, a process called neuroplasticity, but it depends on consistent, repeated practice of the skills being relearned. Caregivers who understand therapy goals and help reinforce exercises at home give stroke survivors more opportunities for that rewiring to happen outside of formal therapy sessions.
This doesn’t mean becoming a physical therapist. It means learning what the rehabilitation team is working on, encouraging practice without pushing too hard, and creating an environment where the person feels supported rather than frustrated. Small things matter: setting up the home to reduce fall risks, keeping commonly used items within reach of the stronger hand, and building predictable daily routines that include time for exercises.
Watch for Depression After Stroke
Depression is one of the most common effects of stroke, and it’s also one of the most overlooked. It goes beyond the sadness you’d expect after a life-changing medical event. Stroke can physically damage the brain areas involved in mood regulation, meaning depression can develop even in someone who seems to be recovering well physically.
Research consistently links lower levels of social support with higher rates of post-stroke depression. Staying connected matters. Regular visits, phone calls, involvement in a stroke support group, or simply spending time together without focusing on the illness can all help. If you notice persistent withdrawal, loss of interest in rehabilitation, changes in sleep or appetite, or expressions of hopelessness, bring it up with their medical team. Post-stroke depression is treatable, but it often goes undiagnosed because both caregivers and patients assume the sadness is just a normal reaction to the stroke itself.