Call 911 immediately. That is the single most important thing you can do when someone is having a stroke. Every minute without treatment destroys roughly 1.9 million brain cells, so the speed of your response directly affects how much brain function the person can recover. While you wait for paramedics, there are specific steps you should take and several things you should avoid.
How to Recognize a Stroke
The classic signs follow the acronym F.A.S.T. Look for facial drooping on one side, arm weakness (ask the person to raise both arms and watch if one drifts down), and slurred or garbled speech. The “T” stands for time: call 911 the moment you notice any of these signs, even if only one is present.
A newer version of the acronym, BE FAST, adds two earlier letters. “B” stands for balance, covering sudden dizziness or loss of coordination, and “E” stands for eyes, covering sudden vision changes like double vision or loss of sight in one eye. These additions matter because the original F.A.S.T. missed about 40% of strokes that occur in the back of the brain, which tend to cause balance and vision problems rather than the classic face and arm symptoms.
Women are more likely than men to show atypical symptoms. In addition to the standard signs, women more often experience sudden confusion, severe fatigue, general weakness, an intense headache, or a change in mental state. These “generalized” symptoms can look like something less serious, which is part of why strokes in women are more often missed or dismissed early on.
What to Do While Waiting for Help
After calling 911, note the exact time you first saw symptoms. This piece of information, called the “last known well” time, is one of the most critical details paramedics and emergency doctors need. It determines whether the person is eligible for time-sensitive treatments that can dissolve or remove the clot causing the stroke. Don’t estimate with vague phrases like “about an hour ago.” Pin down a specific time: “She was fine at 2:15 when we were talking, and I noticed the drooping at 2:30.”
If the person woke up with symptoms, the last known well time is when they went to sleep or were last seen acting normally the night before, not when they woke up. This distinction can change whether they qualify for treatment.
While waiting for the ambulance:
- Keep the person comfortable. Help them lie down or sit in a supported position with their head slightly elevated. If they’re vomiting or losing consciousness, turn them on their side to keep the airway clear.
- Stay calm and reassuring. The person may be frightened, confused, or unable to speak. Let them know help is coming.
- Gather their medical information. If you can, locate a list of medications, and note whether the person has conditions like high blood pressure, diabetes, or an irregular heartbeat. Paramedics use this information to guide treatment decisions.
- Do not give them anything to eat or drink. Strokes commonly impair the ability to swallow safely, and food or liquid can enter the lungs.
- Do not give aspirin. This is a common instinct, but it can be dangerous. About 13% of strokes are caused by bleeding in the brain rather than a clot, and aspirin thins the blood. Giving it to someone with a bleeding stroke could make things worse. Doctors determine the stroke type with a brain scan at the hospital before deciding on any medication.
Why Minutes Matter at the Hospital
About 87% of strokes are ischemic, meaning a blood clot is blocking blood flow to part of the brain. For these strokes, doctors can administer a clot-dissolving medication through an IV, but it works best within a 4.5-hour window from when symptoms started. The sooner it’s given, the more effective it is. In select patients whose stroke timing is uncertain, advanced brain imaging can sometimes extend that window out to 9 hours.
For strokes caused by a large clot in a major brain artery, doctors can also perform a procedure to physically remove the clot using a catheter threaded through a blood vessel. This procedure has a treatment window of up to 24 hours in some patients, and recent research on over 9,000 patients suggests it can still be effective even beyond that window in certain cases. However, the best outcomes consistently come from the fastest treatment.
The 1.9 million neurons lost per minute figure is not just a statistic to motivate urgency. It translates to real losses in function: speech, movement, memory, personality. The difference between a 30-minute response and a 3-hour response can be the difference between walking out of the hospital and needing months of rehabilitation.
What Happens When You Call 911
Calling 911 rather than driving to the hospital yourself triggers a chain of events that saves time. Paramedics begin assessment in the ambulance and, crucially, notify the hospital before arrival. Pre-notification is the single most impactful factor in reducing time to treatment, because it allows the emergency department to assemble the stroke team and prepare the CT scanner before the patient walks through the door. Driving someone to the hospital yourself skips that entire process.
When the paramedics arrive, be ready to tell them the exact time symptoms started (or the last time the person was normal), what medications the person takes, and any relevant medical history you know. If you saw the symptoms begin, you are a more reliable source of timing than the patient, who may be confused or unable to communicate. Stay available to answer questions even after the ambulance leaves, because the hospital team may call you.
Stroke Symptoms That Come and Go
Sometimes stroke symptoms appear and then resolve within minutes. This is called a transient ischemic attack, or TIA, and it’s often described as a “mini-stroke.” It happens when a clot temporarily blocks blood flow and then dissolves on its own. The symptoms are identical to a full stroke: facial drooping, arm weakness, speech difficulty, vision changes, or sudden imbalance.
A TIA is a medical emergency even though the symptoms pass. It signals that a full stroke is likely coming. Up to 1 in 5 people who have a TIA will have a full stroke within the following days to weeks. If someone’s symptoms resolve before the ambulance arrives, do not cancel the call. They still need emergency evaluation and likely treatment to prevent a larger stroke.