If someone near you is having a stroke, call 911 immediately. Every minute without treatment costs roughly 1.9 million brain cells, so the single most important thing you can do is get emergency medical services on the way. While you wait, there are several specific steps that can protect the person and help paramedics act faster when they arrive.
How to Recognize a Stroke
Before you can act, you need to know what you’re looking at. The BE FAST acronym covers the major warning signs:
- Balance: Sudden loss of balance or coordination
- Eyes: Vision changes, including loss of sight in one or both eyes or double vision
- Face: One side of the face droops. Ask the person to smile and look for asymmetry.
- Arms: Weakness on one side of the body. Ask them to raise both arms. If one drifts downward, that’s a red flag.
- Speech: Slurred words, difficulty speaking, or trouble understanding what you’re saying
- Time: Call 911 right now. Do not wait to see if symptoms improve.
Symptoms can appear suddenly and in combination. A person might stumble, slur their words, and look confused all at once. Or they might have only one sign, like sudden vision loss. Any single symptom is enough to call for emergency help.
What to Do While Waiting for Paramedics
Once you’ve called 911, your job shifts to keeping the person safe and still. Here’s what to do in order of priority:
Note the time. The moment symptoms started (or the last time you saw the person acting normal) is one of the most critical pieces of information the hospital needs. This is called the “last known well” time, and it determines which treatments are available. Write it down or set a mental note. If you don’t know exactly when symptoms started, note when you first noticed them.
Keep them still and calm. Do not let the person walk around, drive, or “shake it off.” Movement can worsen the situation. Reassure them that help is coming and encourage them to stay as still as possible.
Position them carefully. If the person is conscious and alert, help them lie down with their head slightly elevated, roughly 30 degrees (about two pillows’ height). This is particularly important if they’re vomiting, having trouble breathing, or seem very drowsy, since it helps reduce pressure in the brain and lowers the risk of choking. If they’re comfortable and breathing normally, a flat position is also fine. If the person is unconscious or vomiting, turn them onto their side so their airway stays clear.
Loosen tight clothing. Unbutton collars, loosen ties or belts, and remove anything that could restrict breathing.
What Not to Do
Some well-meaning actions can actually make a stroke worse. Do not give the person aspirin, even though aspirin is associated with heart attack treatment. About 15% of strokes are caused by bleeding in the brain rather than a blood clot, and aspirin thins the blood. If the stroke turns out to be a bleeding stroke, aspirin can make it significantly more severe. The hospital will do a brain scan first to determine the type of stroke before giving any medication.
Do not give the person food or water. A stroke can impair the ability to swallow, and anything they eat or drink could end up in their lungs. Do not let them fall asleep without monitoring them. And do not drive them to the hospital yourself unless you’re in an extremely remote area with no ambulance access. Paramedics can begin assessment and notify the hospital en route, which saves valuable time once they arrive.
Information Paramedics Will Need
When EMS arrives, they’ll want specific details. Having these ready speeds up everything that follows:
- When symptoms started or the last time the person seemed normal
- What symptoms you observed and whether they got worse
- Medications the person takes, especially blood thinners
- Medical history, including previous strokes, heart conditions, diabetes, or high blood pressure
- Any known allergies
If you have access to the person’s medication bottles, grab them. Paramedics can read the labels faster than most people can recall drug names under stress.
Why Minutes Matter
The standard clot-dissolving treatment for ischemic stroke (the type caused by a blockage) works best when given within 4.5 hours of symptom onset. For every minute that passes, the window narrows and outcomes worsen. A newer procedure that physically removes large clots from blocked brain arteries can be effective up to 24 hours after symptoms start in some patients, but it works best in the first 6 hours and is only an option for certain types of blockages.
This is why the “last known well” time matters so much. If someone went to bed fine at 10 p.m. and woke up at 6 a.m. with stroke symptoms, the clock started at 10 p.m., not 6 a.m. That 8-hour gap could put them outside the window for clot-dissolving treatment. The faster you get help, the more options the medical team has.
If Symptoms Disappear Quickly
Sometimes stroke symptoms last only a few minutes before resolving completely. This is called a transient ischemic attack, or TIA, often referred to as a “mini-stroke.” It can feel like a false alarm, but it’s not. A TIA is a warning. Between 9% and 20% of people who experience a TIA go on to have a full stroke within 90 days, with the highest risk in the first 48 hours.
Even if the person feels completely fine by the time you finish dialing 911, go through with the call. The fact that symptoms resolved doesn’t mean the underlying problem is gone. Emergency evaluation after a TIA can identify the cause and start preventive treatment before a larger stroke occurs.