SignsToSave
12 min Everyday EmergenciesCaring for Aging Parents

Stroke: Every Minute Counts

In 12 minutes you'll know the signs of a stroke and exactly what to do in the first five minutes.

Print this course — or save it as a PDF from the print dialog. Good for a fridge, a glovebox, or a waiting room.

Why this matters

A stroke is a blockage or a bleed that cuts off blood to part of the brain, and brain tissue starts dying within minutes. The treatments that reverse a stroke work well — but they are locked to a clock that starts when symptoms begin, not when you decide to act. Someone in the United States has a stroke about every 40 seconds (Centers for Disease Control and Prevention). The one thing a bystander controls is how fast that person reaches a hospital.

Know the signs

BE-FAST: six things you can check in twenty seconds

You do not need training to spot a stroke. You need six checks, and you can do them from across a dinner table.

  • B — Balance. Sudden dizziness, stumbling, or trouble walking that wasn't there a minute ago.
  • E — Eyes. Sudden trouble seeing out of one or both eyes, blurring, or double vision.
  • F — Face. Ask them to smile. Does one side droop or stay still?
  • A — Arms. Ask them to raise both arms and hold them. Does one drift downward?
  • S — Speech. Ask them to repeat a simple sentence. Is it slurred, wrong, or hard to get out?
  • T — Time. Any one of these, call 911 immediately and note the time.

Stroke symptoms come on suddenly. That is the signature. A headache building for two days is a different problem; one that arrives like a thunderclap in someone who was fine ten minutes ago is this one.

One sign is enough

People wait because only one thing seems wrong. A little slurring, and otherwise Dad seems like Dad. That is exactly how most strokes start.

You are not being asked to decide whether this is a stroke. You are being asked to notice one sign and hand the decision to people with a CT scanner. Emergency teams expect calls that turn out to be something else. Those calls are the system working.

Write down the time it started

This is the one thing only you can provide, and it changes what treatment the hospital can offer.

What doctors need is the last known well time — the last moment the person was definitely normal, not the moment you noticed something wrong. If your mother was talking normally at 7:15 and you saw the droop at 7:40, the answer is 7:15. If someone wakes up with symptoms, it is when they went to bed, because the stroke could have started at any point in the night.

Say it to the dispatcher, then write it down. In a stressful hour it is astonishingly easy to lose.

Why speed changes the outcome

Most strokes are caused by a clot. For those, hospitals can give a clot-dissolving medicine, and in some cases remove the clot with a catheter. Both have strict time windows measured from when symptoms started, and the earlier they are given, the better people do.

That is why an ambulance beats a car. Paramedics assess on the way, radio ahead so the stroke team is waiting, and can drive past a closer hospital to one equipped for stroke care. A private car arrives with none of that in motion.

A mini-stroke that goes away is a warning, not an all-clear

Sometimes stroke symptoms last a few minutes and then vanish completely. That is often a transient ischemic attack (a TIA, or "mini-stroke") — a blockage that cleared on its own.

Relief is the wrong reaction. A TIA warns that a full stroke may follow, and the riskiest period is the days immediately after. Someone whose symptoms resolved still needs emergency evaluation today, not an appointment next week. Do not cancel the ambulance.

What not to do

Do not give food, drink, or medication — including aspirin. Aspirin helps some heart attacks, but a stroke can be a bleed, and aspirin makes bleeding worse. From outside, a clot and a bleed look identical; only a scan tells them apart.

A stroke can also affect swallowing, so anything by mouth risks going into the lungs. And nobody sleeps it off — if symptoms are there at bedtime, the emergency is there at bedtime.

How it really looks

Sunday dinner, and the family debates waiting

Halfway through dinner, Rosa's grandmother sets down her fork and the left side of her mouth isn't moving right. She waves it off — she's tired, it's nothing. Rosa's uncle says give it ten minutes. Rosa asks her grandmother to smile instead, and only half her face does. She calls 911 from the table, tells the dispatcher "face droop, started about five minutes ago, she was completely normal at 6:40," and stays on the line. Her grandmother is in a CT scanner within the hour and treated in time. She is embarrassed about the ambulance for a week, and fine after that.

It cleared up on its own, so it's fine

Marcus is watching a game when his right hand goes clumsy and his words come out wrong. His wife is halfway to the phone when it passes — maybe ten minutes, start to finish. He feels foolish and tells her to forget it. She calls 911 anyway, because symptoms going away is not the same as danger going away. In the emergency department they find a narrowed artery in his neck and start treatment that day. The doctor tells them the episode was a warning shot, and the days right after one are the riskiest.

What to do until help arrives

  1. Call 911 first. Do it before you look anything up, and do not drive them yourself.
  2. Note the last known well time — the last moment they were definitely normal — and tell the dispatcher.
  3. Give nothing by mouth. No food, no water, no aspirin, no other medication.
  4. Help them sit or lie down safely with the head slightly raised, loosen anything tight at the neck, and keep talking to them.
  5. Gather their medication list and allergies — blood thinners especially — for the paramedics.
  6. Unlock the door, turn on the lights, and put the dog away so the crew can walk straight in.
  7. If they become unresponsive and are not breathing normally, start hands-only CPR and tell the dispatcher.

Myths & mistakes

People often think a stroke always causes a dramatic collapse.Actually most strokes are quiet: a drooping lip, a hand that won't cooperate, a sentence that comes out wrong. The person often stays awake, talking, and insisting they are fine.

People often think strokes only happen to the elderly.Actually stroke happens at any age, including young adults and rarely children. Age raises your alertness; it never rules stroke out.

People often think you should give aspirin, the way you would for a heart attack.Actually no. A stroke may be a bleed, and aspirin makes it worse. Only a scan tells a clot from a bleed.

What you learned

  • BE-FAST covers it: Balance, Eyes, Face, Arms, Speech, Time.
  • One sign is enough to call 911. You are not diagnosing anything — you are starting the clock.
  • The last known well time is the single most valuable thing you can hand the hospital.
  • Symptoms that disappear are a TIA, and a TIA is still an emergency today.
  • Nothing by mouth, and never aspirin for a suspected stroke.

Sources

  1. American Stroke Association — Stroke warning signs, F.A.S.T. and stroke treatment
  2. Centers for Disease Control and Prevention — Stroke: signs, symptoms and how often stroke occurs in the US
  3. American Heart Association — Stroke and transient ischemic attack (TIA) patient information

Common questions

What if I call 911 and it turns out not to be a stroke?

Then you did the right thing. Several conditions mimic stroke — low blood sugar, migraine, seizures, some infections — and telling them apart requires a scan and a clinician. Emergency systems are built expecting these calls. Nobody will be annoyed with you, and a call that turns out to be nothing costs far less than a stroke treated three hours late.

Should I drive them to the hospital instead of waiting for an ambulance?

No. Paramedics begin assessing on the way, alert the stroke team so it is ready when you arrive, and can drive past a closer hospital to one equipped for stroke care. Arriving by car means starting from the back of the queue with none of that in motion. Call 911.

My father's symptoms went away after ten minutes. Do we still need to go?

Yes, today. Symptoms that resolve usually mean a transient ischemic attack — a mini-stroke — and a TIA is a warning that a larger stroke may follow, with the greatest risk in the days right after. That window is exactly when treatment can prevent the bigger one. Do not wait for a routine appointment.

Check what you know

Five questions. Four correct to pass. Retake as many times as you like — this is practice, not a test.

This course belongs to Everyday Emergencies · Caring for Aging Parents. Courses that pair well with it:

Heart Attack: Know the Signs In 12 minutes you'll know the classic heart attack signs, the different signs women and people with diabetes often get instead, and exactly what to do. 12 min Everyday EmergenciesCaring for Aging Parents Sudden Confusion in an Older Adult In 12 minutes you'll know how to tell sudden confusion from normal aging, and exactly what to check and report. 12 min Caring for Aging Parents Cardiac Arrest & Hands-Only CPR In 15 minutes you'll know how to recognize cardiac arrest, start hands-only CPR, and use an AED safely. 15 min Everyday EmergenciesCaring for Aging ParentsProtecting Young Kids