Call 911 immediately. A stroke destroys roughly 1.9 million brain cells every minute blood flow is blocked, so the single most important thing you can do is get emergency medical help on the way as fast as possible. While you wait for paramedics, there are several things you can do to help, and a few critical mistakes to avoid.
Recognize the Signs With BE FAST
Before you can help, you need to know what you’re seeing. 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 sudden double vision
- Face: One side of the face droops. Ask the person to smile and look for unevenness.
- 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, garbled sentences, or trouble understanding what you’re saying
- Time: Call 911 right now. Every minute matters.
Not every stroke looks the same. Women in particular can experience subtler symptoms like sudden fatigue, confusion, general weakness, nausea, or vomiting, sometimes without the classic face drooping or arm weakness. If something feels suddenly and seriously wrong, even without textbook symptoms, treat it as an emergency.
Call 911 and Note the Time
Pick up the phone before you do anything else. When you call, tell the dispatcher you suspect a stroke and describe what you’re seeing. One piece of information is especially critical: the “last known well” time. This is the last moment the person seemed completely normal, before any symptoms appeared. If you watched the symptoms start, that’s straightforward. If you found the person already symptomatic, for instance they woke up with slurred speech, the last known well time is when they went to sleep.
This timestamp directly determines which treatments the person qualifies for at the hospital. Clot-dissolving medication can be given within 4.5 hours of symptom onset, and in some cases up to 9 hours with advanced brain imaging. A procedure to physically remove a large blood clot can be performed up to 24 hours after symptoms begin in certain patients. Getting that time wrong by even a small margin could mean someone misses a treatment window or receives treatment when risks outweigh benefits. Studies have found that inaccurate timing would have led to inappropriate treatment decisions in over half of cases reviewed.
Write the time down or note it in your phone. In the stress of the moment, it’s easy to lose track.
What to Do While Waiting for Paramedics
Once you’ve called 911, stay with the person and keep them calm. Here’s what helps:
Have them sit or lie down in a comfortable position. If they’re conscious, sitting slightly upright with head and shoulders elevated is generally best. If they’re unconscious or vomiting, turn them gently onto their side so fluid can drain from the mouth rather than entering the airway. Make sure nothing is restricting their breathing, like a tight collar or tie.
Talk to them reassuringly. Even if they can’t respond clearly, they can likely hear and understand you. Tell them help is on the way. Keep track of any changes in their symptoms, whether things are getting better, worse, or staying the same. This information is useful for paramedics when they arrive.
If you can, unlock the front door or send someone outside to flag down the ambulance. Seconds count, and anything that speeds up the handoff to medical professionals helps.
Do Not Give Aspirin, Food, or Water
This is where good intentions can cause real harm. You might think aspirin is the right call since it helps during heart attacks. But 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 significantly worse. Doctors won’t give aspirin until they’ve done a CT scan to determine which type of stroke it is. You can’t tell the difference by looking at someone, so don’t guess.
Don’t offer food or water either. Strokes frequently impair swallowing, a condition called dysphagia, and the person may not even realize they can’t swallow safely. Food or liquid can slip into the airway and lungs, causing choking or a dangerous chest infection. In some cases, this happens silently with no coughing or visible distress. Hospitals screen every stroke patient’s swallowing ability before allowing them to eat or drink anything, and patients who fail that test are kept on nothing by mouth until a specialist evaluates them.
Do Not Drive Them to the Hospital
It’s tempting to skip the ambulance and drive to the nearest emergency room yourself. Resist that urge. Paramedics can begin assessment and notify the hospital en route, so the stroke team is assembled and ready the moment the patient arrives. Many hospitals have “stroke alerts” triggered by EMS calls that activate specialized staff and imaging equipment before the ambulance pulls in. Driving yourself bypasses all of that, and if the person’s condition worsens in your car, you have no way to help them.
The exception is if you’re in a very remote area where an ambulance would take unreasonably long. In that case, call 911 anyway for guidance while someone else drives.
Why Minutes Matter at the Hospital
Understanding what happens next can reinforce why your quick action matters so much. At the hospital, the team will do a brain scan to determine whether the stroke is caused by a clot (ischemic) or bleeding (hemorrhagic). For clot-based strokes, which account for about 85% of cases, the primary treatments are a clot-dissolving medication given through an IV and, for larger clots, a procedure where doctors thread a catheter through a blood vessel to physically retrieve the blockage.
Both treatments are profoundly time-sensitive. The clot-dissolving medication works best when given as early as possible within the first 4.5 hours. The clot retrieval procedure can be performed later, up to 24 hours in select cases, but outcomes are still better the sooner it happens. Every minute of delay means more brain tissue permanently lost. The phrase neurologists use is “time is brain,” and it’s not an exaggeration: 1.9 million neurons, 14 billion synapses, and 7.5 miles of nerve fibers are destroyed each minute a stroke goes untreated.
Your role as a bystander ends when the paramedics take over. But everything you did in those first minutes, recognizing the signs, calling 911, noting the time, keeping the person safe, directly shapes what treatment options are available and how much brain function can be preserved.