Call 911 immediately. Every minute an ischemic stroke goes untreated, roughly 1.9 million brain cells die. The single most important thing you can do for someone having a stroke is get emergency medical help on the way as fast as possible, then stay with the person until paramedics arrive.
Recognize the Signs With BE FAST
Before you can help, you need to know what you’re looking at. The BE FAST acronym covers the major warning signs:
- Balance: Sudden trouble walking or loss of coordination
- Eyes: Blurred vision, double vision, or sudden vision loss in one or both eyes
- Face: One side of the face droops. Ask the person to smile and see if it’s uneven.
- Arm: Weakness or numbness in one arm. Ask them to raise both arms and watch if one drifts downward.
- Speech: Slurred, garbled, or confused speech. Ask them to repeat a simple sentence.
- Time: Note the exact time symptoms started and call 911 right away.
You don’t need to see all of these signs. Even one is enough to act. The older FAST acronym (Face, Arm, Speech, Time) is still widely used, but the expanded version catches strokes that show up first as balance problems or vision changes, which the shorter version misses.
What to Do While Waiting for an Ambulance
Once you’ve called 911, your job shifts to keeping the person safe and gathering information paramedics will need. Here’s what to do in those critical minutes:
Note the time symptoms first appeared. This is one of the most important pieces of information you can provide. Hospital treatment decisions depend heavily on how long it’s been since the stroke started. If you didn’t witness the onset, try to figure out when the person was last acting normally.
Keep the person calm and still. Don’t move them unless they’re in immediate danger. If they’re conscious, help them sit or lie in a comfortable position. If they’re vomiting or having trouble swallowing, turn them onto their side to keep their airway clear.
Gather their medical information if you can. Paramedics and hospital staff will want to know what medications the person takes (especially blood thinners), any known medical conditions, and any drug allergies. If their medication bottles are nearby, grab them to bring along.
What Not to Do
Some well-meaning actions can actually make things worse during a stroke.
Don’t give aspirin. This is a common instinct because aspirin 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. There’s no way to tell which type of stroke someone is having without a brain scan, so skip the aspirin entirely.
Don’t offer food or water. A stroke often impairs the ability to swallow, even if the person doesn’t realize it. Giving them anything by mouth creates a serious choking and aspiration risk.
Don’t drive to the hospital yourself. It’s tempting to throw the person in the car and race to the ER, but paramedics start collecting critical information and alerting the hospital team while still en route. That head start means doctors can be prepped and ready the moment the patient rolls through the doors. Ambulances also carry equipment to monitor and stabilize the person during transport.
Why Minutes Matter at the Hospital
About 85% of strokes are ischemic, meaning a blood clot is blocking blood flow to part of the brain. For these strokes, a clot-dissolving medication can be given intravenously if the patient arrives within 4.5 hours of symptom onset. The earlier it’s administered, the better the outcome. Hospitals aim to get this treatment started within 60 minutes of a patient walking through the door.
For strokes caused by large clots in major brain arteries, doctors can also perform a procedure to physically retrieve the clot. This option has a longer treatment window, potentially up to 24 hours in some patients, though faster is always better. Hospitals target getting this procedure underway within 90 minutes of arrival.
None of these treatments can happen until doctors perform a CT scan or MRI to confirm whether the stroke is caused by a clot or by bleeding. A clinical exam alone cannot distinguish between the two types. That imaging step is why getting to a hospital quickly matters so much: the treatment clock doesn’t truly start until doctors can see what’s happening inside the brain.
If Symptoms Go Away on Their Own
Sometimes stroke symptoms appear and then vanish within minutes. This is called a transient ischemic attack, often referred to as a mini-stroke. The symptoms are identical to a full stroke: face drooping, arm weakness, speech difficulty, vision changes. The only difference is that they resolve, usually within minutes, though they can last up to 24 hours.
A TIA is still a medical emergency. There’s no way to know in the moment whether symptoms will resolve or worsen, and a TIA is often a warning sign that a full stroke is coming. Treat it exactly the same way: call 911 immediately. Don’t wait to see if the symptoms pass on their own, because every minute you spend watching and waiting is a minute lost if this turns out to be a full stroke rather than a TIA.
Information to Have Ready
Whether you’re the patient or the bystander, the most useful things you can tell emergency responders are:
- Time of symptom onset: The exact time symptoms started, or the last time the person was seen acting normally
- Medications: Especially blood thinners, blood pressure drugs, or diabetes medications
- Medical history: Previous strokes, heart conditions, recent surgeries
- What you observed: Which symptoms appeared, in what order, and whether any got better or worse
Having this information ready can save precious minutes in the emergency room. If you live with someone at higher risk for stroke, keeping a current medication list on the refrigerator or in a phone is a small step that could make a real difference.