Call 911 immediately and note the time symptoms started. Those are the two most important things you can do when someone is having a stroke, and everything else is secondary. The faster that person reaches a hospital, the more brain tissue doctors can save. Treatment is most effective within the first few hours, and every minute of delay increases the risk of permanent damage.
Recognize the Signs With BE FAST
Before you can act, you need to know what you’re seeing. The BE FAST checklist covers the most common stroke warning signs:
- Balance: Sudden loss of coordination, trouble walking, or weakness in the legs
- Eyes: Blurred or double vision, or sudden vision loss in one or both eyes
- Face: One side of the face droops when the person tries to smile
- Arm: One arm drifts downward when both are raised
- Speech: Words come out slurred, jumbled, or the person can’t speak at all
- Time: Call 911 right away and note when symptoms began
These signs can appear alone or in combination. A person doesn’t need all of them for it to be a stroke. Even one is enough to call for help.
Women sometimes present differently. Research shows women are more likely to experience generalized weakness, sudden confusion or disorientation, fatigue, nausea, headache, and changes in consciousness. These “non-traditional” symptoms can look like something less serious, which is one reason strokes in women are more often missed or treated late. If someone suddenly seems confused, disoriented, or profoundly fatigued alongside any of the BE FAST signs, treat it as an emergency.
Call 911 and Track the Time
Do not drive the person to the hospital yourself. Calling 911 gets paramedics to you faster, and they can begin assessing the stroke in the ambulance and alert the hospital before arrival. Emergency dispatchers will ask you a specific sequence of questions: Is the person awake? Are they breathing normally? Can they talk? What symptoms are you seeing? When did this start? Have they had a stroke before? Have answers ready.
The single most critical piece of information you can provide is when the person was “last known well,” meaning the last time they were clearly symptom-free. This is not the same as when you noticed the symptoms. If someone went to bed fine at 10 p.m. and woke up at 6 a.m. with a drooping face, the last known well time is 10 p.m. If you saw them laughing at 3:15 p.m. and they suddenly couldn’t speak at 3:20 p.m., the last known well time is 3:15.
This timestamp directly determines which treatments are available. Inaccurate times can lead to someone being treated outside a safe window, increasing their risk of brain bleeding, or being denied treatment they could have safely received. Write it down or put it in your phone. Don’t guess later.
What to Do While Waiting for Help
Keep the person calm and still. If they’re conscious, have them sit or lie down in whatever position feels most comfortable. Raising the head slightly, around 30 degrees (roughly two pillows), is generally recommended for stroke patients, especially if there’s any concern about vomiting or difficulty breathing. If they’re unconscious or vomiting, turn them on their side to keep the airway clear.
Do not give them aspirin. This is a common instinct because aspirin is recommended during a suspected heart attack, but strokes are different. 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 the difference between a clot-based stroke and a bleeding stroke without a brain scan, giving aspirin is a gamble with serious consequences.
Do not give them food or water either. Strokes often impair the ability to swallow, and anything they try to drink or eat could end up in their lungs. Loosen any tight clothing around the neck or chest, and stay with them until paramedics arrive.
Why Minutes Matter at the Hospital
The main treatment for clot-based strokes is a clot-dissolving medication given through an IV. The benefits of this drug are directly tied to how quickly it’s administered. Guidelines set the target at 60 minutes or less from the moment a patient arrives at the hospital to when the drug enters their bloodstream. Some stroke centers aim for 45 minutes. The standard treatment window extends up to 4.5 hours from symptom onset, though newer guidelines from 2026 allow doctors to extend that window to 9 hours, or even longer, if brain imaging shows there’s still tissue worth saving.
For strokes caused by a large clot blocking a major artery, a procedure called mechanical thrombectomy can physically remove the blockage. Landmark trials have shown this can benefit patients up to 24 hours after symptom onset when imaging confirms salvageable brain tissue. This is one reason getting to a hospital quickly matters even if several hours have passed. Advanced imaging can reveal whether treatment is still worthwhile.
The hospital will perform a brain scan almost immediately to determine whether the stroke is caused by a clot or by bleeding. This distinction drives every treatment decision that follows. It’s also why that “last known well” time you recorded is so valuable: it tells doctors whether the clot-dissolving drug can be given safely or whether the risk of bleeding outweighs the benefit.
If Symptoms Disappear Before Help Arrives
Sometimes stroke symptoms vanish within minutes. This is called a transient ischemic attack, often referred to as a mini-stroke, and it is still a medical emergency. The risk of a full stroke after a TIA is up to 5% within the first 48 hours and as high as 12% within 30 days. Those odds are significant.
Even if the person feels completely fine by the time paramedics arrive, they still need to go to the hospital. Current guidelines recommend urgent brain imaging, not a “wait and see” approach. Imaging can reveal whether the brain has already sustained small areas of damage and whether the blood vessels supplying the brain are narrowed or blocked. A TIA is a warning. Treating it quickly can prevent the larger stroke that often follows.