Stroke: What to Do in the First Ten Minutes

If you think someone is having a stroke, call 911 now. Note the time the first symptom appeared and tell the paramedics. Do not drive them, and do not wait to see whether it passes.

Call 911, and look at the clock. Those are the two things that matter, in that order. The Centers for Disease Control and Prevention is explicit that the stroke treatments which work best are only available if a stroke is recognised and diagnosed within about three hours of the first symptom — which means the single most useful piece of information you can carry into an emergency room is what time it started.

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The signs, as the CDC lists them

B.E. F.A.S.T. — and the first two letters are the ones most people have never heard:

• B — Balance. Sudden trouble walking, dizziness, or loss of balance or coordination
• E — Eyes. Sudden trouble seeing
• F — Face. Sudden numbness or weakness in the face, especially on one side
• A — Arms. Sudden numbness or weakness in an arm or leg, especially on one side of the body
• S — Speech. Sudden confusion, trouble speaking, or difficulty understanding speech
• T — Time. Call 911 right away, and note when it started

The CDC also lists a sudden severe headache with no known cause among the warning signs.

The word doing the work in nearly every line of that list is sudden. Stroke symptoms arrive rather than develop.

Why the time matters so much

Most medical advice about timing is a preference. This one is a gate.

The treatments that reverse rather than merely manage a stroke depend on being inside a window measured from the first symptom — not from when someone noticed, and not from when the ambulance arrived. If nobody knows when it started, the clinical team has to assume the worst case, and some options come off the table.

So: the last moment the person was definitely normal. If they woke up like this, say so — that is a different and important answer. If they were fine at the end of a phone call at 7:15, that is the time. Write it down if you can; people misremember under stress, and they misremember in the direction of thinking less time has passed.

What to do while you wait

Stay with them. Note the time. Keep them sitting or lying comfortably, and stay calm enough to answer questions when help arrives.

Do not give them anything to eat or drink, including water. A stroke can affect swallowing, and someone who cannot swallow safely can inhale what they are given.

Do not give aspirin. Some strokes are bleeds rather than clots, and aspirin makes a bleed worse. This is the single most common well-intentioned mistake, and it is why nothing on this page tells you to give any medication.

Gather their medication list if it is to hand — particularly blood thinners. That answer changes what happens next.

Do not drive them. Paramedics assess and begin treatment on the way, they can alert the emergency room before arrival, and they route to the facility that can do what this patient needs. A car does none of that.

If the symptoms go away

Call 911 anyway.

Symptoms that resolve within minutes can mean a transient ischaemic attack, and the reason that matters is uncomfortable: it is frequently a warning that a larger stroke is coming, sometimes within days. The window in which anything can be done about that is short, and it starts now rather than when the next episode happens.

“It passed, so I did not call” is the most expensive sentence in this subject.

What happens in the emergency room

Stroke is triaged at the top. Expect imaging quickly — both of our emergency rooms have CT in the building, staffed around the clock, and a CT is how a bleed is told apart from a clot, which is the fork that determines every decision after it.

Our emergency rooms are freestanding, and stroke care frequently needs a hospital afterwards. We assess, image, stabilise and treat to Arizona standard, and where a patient needs to be admitted or needs a level of care we do not provide, we arrange the transfer. In a stroke, that is the point — the priority is getting imaged and treated fast, then getting to the right bed, and the nearest door is the one that starts the clock running in your favour.

That is also why the honest instruction is go to the nearest emergency room, not ours specifically, and let 911 choose. Minutes matter more than continuity.

Questions people actually ask

They seem confused but they can talk. Is that a stroke? It can be. Sudden confusion is on the CDC’s list in its own right.

They are too young for a stroke, surely? Strokes happen in young adults and occasionally in children. Age changes the odds, not the response.

Should I drive them if we are close? No. Paramedics start the assessment on the way and can alert us before you arrive.

What if I call and it turns out to be something else? Then it was something else, checked quickly. That is the correct outcome of a stroke call.

What is the single most useful thing I can do? Note the time the first symptom appeared, and say it out loud to the paramedics.

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If you think someone is having a stroke, call 911 and note the time it started. Both of our emergency rooms are open 24 hours a day, every day of the year, with CT and a full laboratory in the building. Find your nearest emergency room →

Related reading: which door do you need · when to go to the emergency room for chest pain

Sources

2. Signs and Symptoms of Stroke — Centers for Disease Control and Prevention. https://www.cdc.gov/stroke/signs-symptoms/index.html
3. Recognizing medical emergencies — MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. https://medlineplus.gov/ency/article/001927.htm

This article is general information, not a diagnosis, and it cannot account for someone’s history or medications. If you are unsure, come in — this list is not exhaustive and you are not expected to diagnose anyone. If it might be an emergency, treat it as one and call 911.