If someone is having a stroke, call 911 immediately. Do not drive them to the hospital. Every minute without treatment kills roughly 1.9 million brain cells, and the most effective clot-dissolving treatments must be given within 4.5 hours of symptom onset. Your job as a bystander is to recognize the stroke, make the call, note the time, and keep the person safe until paramedics arrive.
Recognize the Signs With BE-FAST
Before you can help, you need to know what you’re looking at. The acronym BE-FAST covers the major warning signs:
- Balance: Sudden loss of coordination, unsteady walking, or unexplained dizziness.
- Eyes: Blurred vision, double vision, or sudden loss of vision in one or both eyes.
- Face: Ask the person to smile. If one side of the face droops or looks uneven, that’s a strong indicator.
- Arms: Ask them to raise both arms. If one arm drifts downward or can’t be lifted, one side of the body is weakening.
- Speech: Ask them to repeat a simple sentence. Slurred, garbled, or absent speech points to a stroke.
- Time: Note exactly when symptoms started and call 911 right away.
Even if these symptoms appear briefly and then disappear, treat them as an emergency. A temporary episode (sometimes called a mini-stroke) can precede a full stroke within hours or days.
What to Do While Waiting for Paramedics
Once you’ve called 911, your priorities are simple: stay with the person, keep them safe, and gather information for the arriving medical team.
If the person is conscious and alert, help them sit or lie down in a comfortable position. If they are responsive but drowsy, drooling, or having trouble swallowing, place them in the recovery position: gently roll them onto their side with their mouth pointing toward the ground. This keeps saliva or vomit from blocking their airway.
Do not give them anything to eat or drink. A stroke commonly impairs the ability to swallow, even if the person doesn’t realize it. Food, water, or pills can slip into the lungs and cause a dangerous complication called aspiration.
Do not give aspirin. You might assume aspirin helps because it thins the blood, but roughly 15% of strokes are caused by bleeding in the brain rather than a clot. Giving a blood thinner during a bleeding stroke can make things worse. There is no way to tell which type of stroke someone is having without a brain scan at the hospital, so leave medication decisions to the emergency team.
What to Tell the Paramedics
The single most important piece of information you can provide is the “last known well” time. This is not necessarily when symptoms started. It’s the last time the person was clearly normal. If you were talking to them at 2:00 p.m. and they seemed fine, then you found them slumped over at 2:30 p.m., the last known well time is 2:00 p.m.
This timestamp directly determines which treatments are available. Clot-dissolving medication is standard within 4.5 hours of symptom onset. A mechanical procedure to physically remove a clot can be performed up to 24 hours later in some patients, if brain imaging shows salvageable tissue. When no one witnessed the onset, such as when a person wakes up with symptoms, the window is harder to establish and treatment options narrow. Your observation of the timeline can make the difference.
Beyond the time, tell paramedics:
- Which symptoms you noticed and in what order
- Any medications the person takes (check for a medical alert bracelet)
- Whether the person has any known conditions like high blood pressure, diabetes, or a previous stroke
If the Person Has a Seizure
Seizures can happen during a stroke. If one occurs, do not hold the person down or put anything in their mouth. Ease them to the ground if they’re falling, clear away nearby objects that could cause injury, and place something soft under their head. Gently roll them onto their side with their mouth pointing downward so the airway stays clear.
Time the seizure. If it lasts longer than five minutes, or if a second seizure follows closely after the first, tell the 911 dispatcher. Once the seizure ends, stay with the person, keep them on their side, and wait for them to become alert.
If the Person Becomes Unconscious
Check whether they are breathing. If they are, place them in the recovery position on their side and monitor their breathing continuously until help arrives. If they stop breathing and you are trained in CPR, begin chest compressions. Update the 911 dispatcher on any changes so the arriving team knows what to expect.
Why Getting to the Hospital Fast Matters
There are two main types of stroke. The most common, accounting for about 85% of cases, is caused by a blood clot blocking an artery in the brain. The other type is caused by a blood vessel bursting and bleeding into the brain. Both are emergencies, but they require opposite treatments: clot-dissolving drugs for one, surgery to stop bleeding for the other. A CT scan at the hospital tells doctors which type they’re dealing with, and treatment begins from there.
For clot-caused strokes, the American Heart Association’s 2026 guidelines endorse clot-dissolving medication within 4.5 hours and mechanical clot removal for up to 24 hours in selected patients. Some hospitals now deploy mobile stroke units, essentially ambulances equipped with CT scanners, that can diagnose and begin treatment before the patient even reaches the emergency department. But all of this depends on how quickly the stroke is recognized and the call is made.
The first aid for a stroke is not complicated. You are not expected to treat it. You are expected to identify it, call for help, record the time, and keep the person safe. Those four actions are the most powerful thing any bystander can do.