Stroke Warning Signs and the First Hour

The FAST signs

The simplest memory aid is FAST:

• F, Face: Ask the person to smile. Does one side of the face droop or look uneven?
• A, Arms: Ask them to raise both arms. Does one arm drift down or can they not lift it?
• S, Speech: Ask them to repeat a simple sentence. Is speech slurred, strange or are they unable to speak or understand?
• T, Time: If you see any of these signs, call 112 immediately, even if the signs seem to go away.

Other sudden signs that can also mean stroke:

• sudden numbness or weakness in the leg, or one side of the body;
• sudden confusion, trouble understanding or finding words;
• sudden trouble seeing in one or both eyes, or double vision;
• sudden loss of balance, dizziness or difficulty walking;
• sudden severe headache with no known cause, sometimes with vomiting or neck stiffness;
• a drooping eyelid, or difficulty swallowing.

Stroke signs usually come on suddenly. Pain is often absent, which is why people delay. Older adults, and women, may have less typical signs such as sudden confusion, weakness, fainting or hiccups. If in doubt, treat it as a stroke.

What to do in the first minutes

1. Call 112 at once (India's emergency number; some states also use 108 for ambulances). Say clearly: "I think this is a stroke." Give the exact address, landmarks and the person's age. Do not wait for symptoms to improve. Do not first call relatives. 2. Note the time when symptoms started, or when the person was last seen well. If they woke up with symptoms, the time is when they went to sleep. This time decides which treatments are possible. Write it down. 3. Keep the person safe and calm. Lay them down with the head and shoulders slightly raised if they are drowsy or weak, or sit comfortably if they prefer. If they are drowsy or vomiting, place them on their side, with support, to keep the airway clear. 4. Loosen tight clothing, remove dentures if loose, and stay with them. 5. Do not give food, drink or medicines, because swallowing may be unsafe, and some tablets may do harm. Do not give aspirin or any tablet unless a doctor or the emergency service tells you to. 6. Do not let them walk about, drive or go alone. 7. Check breathing and responsiveness. If they stop breathing or collapse, follow the instructions of the emergency operator and begin CPR if trained. 8. Have medicines ready: collect the person's medicine list or packets, especially blood thinners, as the hospital must know. 9. Unlock the door and switch on lights so the ambulance crew can enter; see key safe guide. 10. Send someone to the gate to guide the ambulance, in a society; see safety in gated societies and apartments. 11. Prepare to go with the person, bringing identity, insurance papers and a phone charger; see emergency bag for a hospital visit.

What not to do

• Do not wait and watch. Delay reduces treatment options.
• Do not take the person to a clinic or family doctor first, unless the ambulance cannot come. A hospital with a CT scanner and stroke team is needed.
• Do not give home remedies, such as ghee, honey, garlic, tea, water, turmeric, or press or cut fingers or ears. They do not help and can delay care or cause choking.
• Do not give blood pressure medicines on your own to "lower" pressure; blood pressure may need to stay high at first to protect the brain. Follow doctors' instructions.
• Do not let the person sleep it off without calling for help.
• Do not drive in a panic if an ambulance can come, unless advised; if driving, have another adult look after the patient.
• Do not argue about whether it is a stroke. Let the hospital decide.

Why time matters

During a stroke caused by a blocked artery, about two million brain cells die every minute without treatment. Clot-dissolving medicine (thrombolysis) works best within about four and a half hours of the start of symptoms, and some procedures to remove a clot (thrombectomy) can be done up to many hours later in selected patients, after imaging. A bleed in the brain needs different urgent treatment. The hospital cannot give any of these safely without a scan and a clear time of onset. So the first call and the time noted are the family's most valuable contributions. Sometimes called "time is brain", this principle applies.

Transient ischaemic attack (TIA, mini-stroke)

A TIA is a temporary blockage that produces stroke symptoms lasting minutes to hours, and then goes away completely. It is a warning, and the risk of a full stroke within days is high. Treat it as an emergency: call 112 even if symptoms have gone. Doctors will investigate the cause, such as narrowed neck arteries or an irregular heartbeat, and start preventive treatment; see preventing a second stroke and atrial fibrillation and blood thinners.

Conditions that can look like stroke

Low blood sugar, seizures, migraine, infections, medicine effects and other illnesses can mimic a stroke. People with diabetes who have sudden weakness or confusion should have their sugar checked if a meter is available and the check is quick, while the ambulance is on its way; see diabetes and low-sugar emergencies. Do not delay calling 112 to do so. Delirium from infection can cause sudden confusion; see delirium in older adults.

What happens at the hospital

Staff will check airway, breathing, circulation and blood sugar, take a history, examine the nervous system and do a brain scan (CT or MRI) to tell a clot from a bleed. Blood tests and an ECG are done. Treatment options depend on the type and timing: clot-dissolving medicine, clot removal, blood pressure management, or neurosurgical care for bleeds. Then admission to a stroke unit, assessment of swallowing, early mobilisation, and tests to find the cause. Tell the team: the time of onset, medicines (especially blood thinners), allergies, other illnesses, recent surgery or injury, and any similar episodes earlier.

Prepare before an emergency

• Learn FAST and teach every adult and teenager in the household.
• Know the nearest hospital with a CT scan and stroke care, and the route, in your city. Ask your family doctor which hospital is best, and whether it has 24-hour stroke services; see ambulance and emergency numbers in India.
• Keep 112 and key numbers on the phone and the refrigerator.
• Keep a medical summary and medicine list where the family and ambulance crew can find them; see emergency contact card and medical summary.
• Make sure someone can get in if an older person lives alone: a key safe or neighbour; see home safety for seniors living alone.
• Consider a wearable alarm for those at high risk who live alone; see panic pendant buying guide.
• Check and treat risk factors: blood pressure, diabetes, irregular heartbeat, cholesterol, smoking; see hypertension home care guide and how to measure blood pressure at home.
• Know insurance details and have papers ready; see health insurance for senior citizens in India.

After the emergency

If the person recovers well, still go for review, since a stroke or TIA signals risk. If there are lasting effects, recovery begins in hospital; see stroke recovery at home guide and caring for a parent after stroke. Prevention, with the doctor's guidance on blood pressure, medicines and habits, matters most; see preventing a second stroke.

Special situations

• Person living alone: if you find someone with stroke signs, call 112 first, then family.
• Person on blood thinners: tell the emergency team immediately; they affect treatment.
• Person with dementia: sudden change in speech or movement still needs urgent assessment.
• Person who wakes with symptoms: call 112; the time last seen well is used.
• Symptoms that improve: still call 112.
• At night: still call; do not wait for morning.
• Travelling: call 112 and find the nearest major hospital.

When to ask a professional

Ask your doctor about your own and your parent's stroke risk, blood pressure, heart rhythm, diabetes and cholesterol, and what to do in an emergency. A cardiologist or neurologist can advise on prevention. Local first-aid or basic life support classes teach how to respond. For senior services, call Elderline 14567. In a suspected stroke, call 112 immediately.