What should you do if someone has a stroke?

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Knowing how to spot the signs of a stroke and what to do next can save a life.

Recognize the signs and call 911

The first step is to recognize the signs of a stroke. Use the acronym FAST to help you remember:

• F = Face: Has the person’s face changed? Is the mouth drooping on one side? Is their smile straight or lopsided?
• A = Arms: Can they raise both arms? Can they hold them up, or do the arms drift down?
• S = Speech: Can the person repeat a simple sentence? Is their speech slurred?
• T = Time: If the answer to any of the above is yes, call 911.

For more on signs and symptoms of a stroke, see the “Symptoms” section below.

Find out how to tell the difference between a stroke and a heart attack.

After calling 911

• Remain calm.
• Ensure the surrounding area is safe and that there is no imminent danger to the person, such as from moving vehicles.
• Talk to the person. Ask them their name and other questions. If they cannot speak, ask them to squeeze your hand in response to questions. If the person does not respond, they are likely unconscious.

If the person is conscious:

• Gently place them into a comfortable position. Ideally, they should be lying on their side with their head and shoulders slightly raised and supported with a pillow or item of clothing. After this, try not to move them.
• Loosen any tight clothing, such as buttoned-up shirt collars or scarves.
• If they are cold, use a blanket or coat to keep them warm.
• Check that their airway is clear. If there are objects or substances, such as vomit, in the mouth that may be hindering breathing, place the person on their side in the recovery position (see below).
• Reassure the person. Tell them that help is on the way.
• Do not give them any food or liquids.
• Note the person’s symptoms and look for any changes in condition. It is important to give the emergency personnel as much information as possible about the situation.
• Try to remember the time that the symptoms started. Look at a clock if possible, as it is hard to estimate the passage of time when you are in a stressful situation.

If the person is unconscious:

• Move them into the recovery position (see below).
• Monitor their airway and breathing. To do this:
  • lift the person’s chin and tilt their head slightly backward
  • look to see if their chest is moving
  • listen for breathing sounds
  • place a cheek over their mouth and try to feel their breath
• If there are no signs of breathing, begin CPR (cardiopulmonary resuscitation)

Current practice for CPR is for people who are not formally trained in the procedure to do chest compressions only. 911 can instruct you how to do this if you do not know how.

The recovery position

If someone is unconscious, or if their airway is not completely clear, place them in the recovery position. To do this:

1. Kneel beside them.
2. Take the arm that is farthest away and place it at a right angle to their body.
3. Place the other arm across their chest.
4. The leg that is farthest away should remain straight. Bend their other knee.
5. Support their head and neck and roll the person onto their side, so that their bottom leg is straight and their top leg is bent at the knee, with that knee touching the ground.
6. Tilt their head slightly forward and down so that any vomit in the airway can drain out.
7. Manually clear out the person’s mouth, if necessary.

Performing cardiopulmonary resuscitation (CPR)

CPR is a lifesaving technique that can be performed to help people whose breathing and heartbeat have stopped. If someone who has had a stroke is not breathing, performing CPR until the emergency services arrive may save their life.

For people who have not received training in CPR, the American Heart Association (AHA) recommend initiating hands-only CPR on teenagers and adults.

It consists of two steps:

1. Calling 911.
2. Pushing hard and fast in the center of the chest.

People who have received training and have a mouth guard can deliver high-quality chest compressions and rescue breaths at a rate of 2 breaths to every 30 compressions. If they do not have a mouth guard, they should only do compressions.

If an automated external defibrillator device (AED) is available, it can be used to check heart rhythm and deliver an electric shock to the chest, if necessary.

Recognizing the signs and symptoms of a stroke is vital. Some symptoms can be subtle while others are more noticeable.

A stroke can affect individuals differently, and not everyone will experience all the symptoms. However, below are some of the most common ones.

As a reminder, use the FAST acronym to recognize stroke symptoms:

• Face: Is there weakness or drooping on one side of the face?
• Arms: Can they raise both arms?
• Speech: Is their speech slurred or difficult to understand?
• Time: If any of the above apply, call 911 without delay.

Other symptoms of stroke include:

• weakness and numbness on one side of the face or body
• vision problems affecting one or both eyes
• difficulty talking or understanding speech
• coordination problems and loss of balance
• severe and sudden headache
• sudden confusion
• dizziness
• loss of consciousness

Even if symptoms last just a few minutes or hours, the person needs emergency medical attention. It may be a sign of a mini-stroke, or transient ischemic attack (TIA), which can be a warning of a major stroke to come.

What does a stroke feel like? Find out here.

Emergency first aid treatment is the same for all strokes, regardless of their cause. These are the two main types of stroke and their causes:

Ischemic stroke

Ischemic stroke is the most common type. It is caused by a blockage or narrowing of the arteries that carry blood to the brain. The blockages may be caused by blood clots or fatty deposits.

Hemorrhagic stroke

These happen when arteries in the brain leak blood or break. This blood damages brain cells and reduces blood supply to the brain.

Learn more here about the types of stroke.

The following factors increase the risk of stroke:

• high blood pressure
• high cholesterol
• history of stroke
• diabetes
• heart disease
• smoking

The risk of stroke increases with age, but the CDC note that, in 2009, over one-third of people who received hospital treatment for a stroke were under 65 years of age. Strokes can also affect children, with infants under 1 year having the highest risk in this group.

In the U.S., Black Americans are twice as likely as white Americans to have a stroke. Native Americans, Alaskan Natives, and Hispanic adults also have a higher risk than white people.

At the hospital, doctors will examine the person and may carry out tests such as an MRI or CT scan to help confirm the diagnosis and identify the cause.

Treatment options include:

• medication
• physical therapy
• speech therapy
• lifestyle measures
• surgery

The doctor might administer medications to address blood clots and reduce the risk of long-term effects.

The outlook for people who have had a stroke varies. Age, overall health, and lifestyle choices can affect recovery and the risk of having another stroke.

According to the ASA, one quarter of people who have one stroke will have another one at some time. However, following a treatment plan that includes medication such as aspirin and lifestyle measures can prevent 80% of strokes and heart attacks.

Speedy intervention is vital. It can take months or years to recover from a stroke, and some people will experience lifelong challenges.

However, the CDC advise that people who arrive at the emergency room within 3 hours of the appearance of stroke symptoms are less likely to experience disability than those who received delayed care.