Every minute counts during a stroke. The single most important thing you can do is call 911 immediately and note the time symptoms started. Beyond that call, there are several steps that can meaningfully improve the person’s outcome while you wait for paramedics.
Recognizing a Stroke With BE-FAST
Before you can respond, you need to know what you’re seeing. The BE-FAST checklist covers the most common stroke warning signs:
- Balance: sudden trouble with coordination or walking
- Eyes: blurred or double vision, or sudden vision loss in one or both eyes
- Face drooping: one side of the face droops or feels numb (ask the person to smile and look for unevenness)
- Arm weakness: one arm is weak or numb (ask the person to raise both arms and watch if one drifts downward)
- Speech difficulty: slurred or garbled speech, or inability to speak (ask them to repeat a simple sentence like “the sky is blue”)
- Time: call 911 right away if any of these signs appear
Not every stroke looks the same. Some people experience a sudden, severe headache with no known cause. Others may become confused or have trouble understanding simple instructions. Any combination of these signs appearing suddenly warrants an emergency call, even if the person seems otherwise fine.
Why You Should Call 911, Not Drive
It can feel faster to throw someone in the car and race to the hospital. In reality, calling 911 gives the person a significant advantage. When paramedics suspect a stroke, they notify the hospital in advance so the right specialists are standing by when the ambulance arrives. The person can be taken straight for a brain scan to determine whether the stroke is caused by a clot or by bleeding, a distinction that completely changes the treatment.
Paramedics can also monitor for sudden changes and intervene if the person’s condition deteriorates during transport. Driving yourself means none of that happens, and the person still has to go through a standard intake process once they arrive at the ER.
What to Do While Waiting for Paramedics
Once you’ve called 911, your next actions matter more than most people realize.
Lay the person down flat. Recent clinical trial data found that keeping the head at zero degrees (flat, not elevated) helped maintain neurological stability in stroke patients awaiting treatment. Because most people instinctively prop someone up or the person is found sitting, this may require gently repositioning them. If they are vomiting, turn them on their side to keep the airway clear.
Do not give the person anything to eat or drink. Up to 50% of stroke patients have difficulty swallowing, and up to a third of those with swallowing problems aspirate, meaning food or liquid enters the airway instead of the stomach. Pneumonia develops in more than a third of people who aspirate, and nearly 4% die from it. Even a sip of water can be dangerous.
Do not give aspirin. This is a common and potentially deadly mistake. Aspirin thins the blood, which helps if the stroke is caused by a clot. But roughly 15% of strokes are caused by bleeding in the brain, and aspirin makes that bleeding worse. There is no way to tell which type of stroke is happening without a hospital brain scan. Giving aspirin to someone with a hemorrhagic stroke can be fatal.
The Most Important Thing You Can Tell Paramedics
The medical team needs one piece of information above all else: when the person was last known to be normal. Not when you found them with symptoms, but the last time you can confirm they were fine. This is called the “last known well” time, and it determines whether the person qualifies for clot-dissolving treatment.
Be as specific as possible. “About an hour ago” is nearly useless because that phrase gets repeated by multiple providers over the next several minutes or hours, becoming increasingly inaccurate. Instead, say something like “I spoke to her at 2:15 and she was fine. When I came back at 2:45, she couldn’t speak.” If the person woke up with symptoms, the last known well time is when they went to sleep, not when they woke up.
Paramedics will also want to know:
- Current medications, especially blood thinners, and when the last dose was taken
- Medical history, particularly high blood pressure, irregular heartbeat, diabetes, or any previous strokes
- Recent surgeries or bleeding events
- Known allergies, especially to contrast dye
If the person lives alone and you don’t know their medical history, check for a medication list on the refrigerator, in their wallet, or on their phone. Grab any medication bottles you can find and bring them along.
Why Every Minute Changes the Outcome
Stroke treatment is brutally time-sensitive. The primary clot-dissolving medication is only approved for use within 3 hours of symptom onset, with an extended window of up to 4.5 hours for some patients. Beyond that, the drug causes more harm than good, particularly dangerous bleeding in the brain.
For strokes caused by a large clot blocking a major artery, a procedure to physically remove the clot can be performed up to 24 hours after symptoms begin, depending on the location and severity. But outcomes are dramatically better the earlier it happens. Within the first 6 hours, the evidence is strongest. Between 6 and 24 hours, patients may still benefit, but only if brain imaging shows enough salvageable tissue. The 2026 American Heart Association guidelines reinforced that this procedure is now standard for qualifying patients and expanded eligibility to include people with larger areas of damage than previously allowed.
The bottom line: faster recognition and faster transport directly translate into more treatment options and better recovery.
If Symptoms Disappear Before Help Arrives
Sometimes stroke symptoms vanish within minutes. This is a transient ischemic attack, often called a mini-stroke, and it is a medical emergency even though the person feels fine again. About 23% of full strokes are preceded by a TIA, and the risk of a major stroke is roughly 4% within the first 2 days and 9% within the first month.
Do not cancel the ambulance. Do not let the person talk you out of going to the hospital because “it passed.” The disappearance of symptoms does not mean the danger has passed. It means the brain is sending a clear warning that a larger stroke may be imminent. Patients who are evaluated and treated urgently after a TIA have significantly lower rates of subsequent stroke compared to those who wait.