What Are the Signs of a Stroke? A FAST Guide for Care Workers

The main signs of a stroke are sudden face weakness, arm weakness and speech problems — remembered as FAST: Face, Arms, Speech, Time to call 999. But FAST only picks up the three most common signs. A stroke can also show as sudden loss of vision, dizziness or a fall, confusion, a severe headache or numbness down one side of the body. And if the symptoms stop after a few minutes, that is not the all-clear: the NHS says to call 999 if someone has had signs of a stroke in the last 24 hours, even if they have now stopped.

At a glance: Nexis CPD’s £9 Stroke Awareness course covers recognising a stroke, acting quickly and supporting people afterwards. It is CPD accredited and 100% online with a verifiable e-certificate, and any three courses cost £18. It is awareness training, not a clinical or regulated qualification.

What are the signs of a stroke?

A stroke happens when the blood supply to part of the brain is cut off. The NHS describes it as “when blood stops flowing to a part of your brain”, and says it “needs urgent medical help in hospital because it can be life-threatening”.

The NHS stroke symptoms page lists the main symptoms as:

• Face weakness — one side of the face may droop and it might be hard to smile.
• Arm weakness — the person may not be able to fully lift both arms and keep them there because of weakness or numbness in one arm.
• Speech problems — they may slur their words or sound confused.

It then lists other signs that someone may be having a stroke:

• weakness or numbness down one side of the body;
• blurred vision or loss of sight in one or both eyes;
• finding it difficult to speak or think of words;
• confusion and memory loss;
• feeling dizzy or falling over;
• a severe headache;
• feeling or being sick.

The NHS adds that a stroke “is more likely to happen if you’re older, but it can happen at any age”. The Stroke Association puts the scale at around 100,000 strokes a year in the UK, with 1.4 million stroke survivors. In care, it is something you should expect to recognise.

What does FAST stand for?

FAST is the test the NHS and the Stroke Association teach the public, and it is the screening approach the National Institute for Health and Care Excellence (NICE) points to for use outside hospital. Recommendation 1.1.1 of NICE guideline NG128 says to “use a validated tool, such as FAST (Face Arm Speech Test), outside hospital” to screen people with sudden neurological symptoms for stroke or a transient ischaemic attack (TIA).

The Stroke Association’s version turns each letter into a question you can ask:

• F — Face: Can the person smile? Has their mouth or eye drooped?
• A — Arms: Can the person raise both arms fully and keep them there?
• S — Speech: Can the person speak clearly and understand what you say? Is their speech slurred?
• T — Time: Time to call 999 if you see any one of these signs.

The important word is any. You do not need all three. The Stroke Association puts it plainly: “Face or Arm or Speech, at the first sign, it’s Time to call 999.” A slight droop on one side of the mouth on its own is enough.

How do you check someone using FAST?

The checks take less than a minute and need no equipment. Stay calm and explain what you are doing — fear can make speech harder.

1. Face: ask them to smile. Look for one side of the mouth not lifting, or an eye or mouth corner drooping.
2. Arms: ask them to raise both arms in front of them and hold them there. Watch for one arm drifting down or not lifting at all.
3. Speech: ask a simple question, such as their name. Listen for slurred or garbled words, the wrong words, or difficulty understanding you.
4. Time: call 999 and note the time. When the symptoms started — or the last time the person was definitely seen well — is one of the most useful things you can tell the ambulance crew.

Compare what you see with what is normal for that person. Some people already have a facial droop, a weak arm or speech difficulties from an earlier stroke or another condition. What matters is a new and sudden change — which is why care plans and handovers that describe how someone usually moves and speaks are so valuable.

Which stroke symptoms does FAST miss?

This is the part most quick guides leave out. FAST is designed to catch the most common signs, and the Stroke Association says so directly: “The FAST test helps spot the three most common signs of stroke. But there are other signs and symptoms that you should always take seriously.” Its list matches the NHS one above: sudden weakness or numbness on one side (including legs, hands or feet), sudden blurred vision or loss of sight, sudden memory loss or confusion, sudden dizziness, unsteadiness or a fall, and a sudden, severe headache.

So someone can be having a stroke and still smile evenly, lift both arms and speak clearly. That is exactly why the NHS and the Stroke Association list these other signs alongside FAST rather than relying on FAST alone.

In a care setting, the practical message is simple: a normal FAST check does not rule a stroke out. If someone suddenly cannot see properly, suddenly cannot stand when they could an hour ago, suddenly becomes confused, or complains of a sudden severe headache, call 999. You do not have to be sure it is a stroke — that is the paramedics’ and hospital’s job.

What should you do if you think someone is having a stroke?

Call 999 straight away. The NHS says to call 999 now if “you think you’re having, or have had a stroke”. The Stroke Association adds: “Even if it doesn’t seem like much, any one of these signs of stroke is an emergency, so always call 999 immediately.”

While you wait, these are sensible, practical steps for a care setting. Always follow the advice the 999 call handler gives you.

1. Call 999 and say you think it is a stroke. Tell the call handler what you saw and when it started.
2. Note the time. If nobody saw the symptoms start — for example, the person woke up with them — write down the last time they were definitely seen well.
3. Stay with the person and reassure them. They may understand more than they can say.
4. Keep them safe. Support them so they cannot slump or fall. If they become drowsy or unconscious but are breathing, follow your first aid training and the call handler’s instructions.
5. Do not give them anything to eat or drink — see below.
6. Do not drive them to hospital yourself. The NHS says, “Do not drive yourself to A&E”, and the same applies to driving someone else. The Stroke Association notes that ambulance paramedics “are trained in stroke” and will make sure the person gets emergency and specialist care.
7. Gather their care plan and medicines list for the crew, and be ready to start CPR if they stop breathing normally.

Follow your employer’s emergency procedure too — for example, telling the nurse or senior on shift — but never let an internal process delay the 999 call.

Why does time matter so much in a stroke?

Because the most effective treatments only work within a limited window. The NHS treatment page explains that in the first 24 hours treatment may include “medicine to get rid of blood clots in the brain (thrombolysis)” and “surgery to remove a blood clot (thrombectomy)”.

NICE guideline NG128 sets out the time frames:

• Thrombolysis (clot-dissolving medicine) is considered for acute ischaemic stroke “within 4.5 hours of symptom onset and when intracranial haemorrhage has been excluded” (recommendation 1.4.1).
• Thrombectomy (mechanically removing the clot) should be offered “as soon as possible and within 6 hours of symptom onset” for suitable patients (1.4.5), and can be offered up to 24 hours after the person was last known to be well in some cases, “including wake-up strokes”, if scans show brain tissue that can still be saved (1.4.6).

Only a hospital can decide whether these treatments are suitable, after scans. But you can see why “last known to be well” matters: if a care worker can say “she was chatting normally at 2.15pm”, the hospital has a clear starting point. If nobody knows, the clock may have to start from the last time anyone checked — a strong argument for recording observations at the time, especially overnight.

What if the stroke symptoms go away?

Call 999 anyway. This is where well-meaning people get it wrong. The NHS says “symptoms of a stroke can sometimes stop after a short time, so you may think you’re OK. Even if this happens, get medical help straight away”, and that you should call 999 if “you’ve had signs of a stroke within the last 24 hours even if they’ve now stopped”.

Symptoms that come and go may be a transient ischaemic attack (TIA), sometimes called a mini-stroke, caused by a temporary disruption in the blood supply to part of the brain. The NHS explains why it is still an emergency:

• “In the early stages of a TIA, it’s not possible to tell whether you’re having a TIA or a full stroke.”
• “Even if the symptoms disappear while you’re waiting for an ambulance to arrive, you still need to be assessed in hospital.”
• A TIA “is a warning sign that you may be at risk of having a full stroke in the near future”.

NICE recommendation 1.1.5 says people with a suspected TIA should be referred immediately for specialist assessment, “to be seen within 24 hours of onset of symptoms”. So do not cancel the ambulance because the person “seems fine now” — tell the call handler the symptoms have stopped and let them decide.

Should you give aspirin, food or drink to someone having a stroke?

No — not unless a clinician tells you to. A stroke can be caused either by a clot or by bleeding in the brain. The NHS diagnosis page explains the difference: an ischaemic stroke “happens when a blood clot blocks blood flow to the brain”, while a haemorrhagic stroke “happens when a blood vessel bursts”. Only a scan can tell which.

NICE reflects this. For acute stroke, aspirin is recommended for people “who have had a diagnosis of intracerebral haemorrhage excluded by brain imaging” (recommendation 1.4.9) — in other words, after a scan has ruled out a bleed. For a suspected TIA, NICE does recommend aspirin be started immediately (1.1.4), but that is a clinical decision made by a healthcare professional who has assessed the person. It is not something for a care worker to give on their own initiative.

Food and drink are a separate risk. A stroke can affect swallowing. NICE recommendation 1.6.1 says people with acute stroke should have their swallowing screened by an appropriately trained healthcare professional “before being given any oral food, fluid or medication”. Until that has happened, giving a drink — even water — risks choking or fluid going into the lungs.

If regular medicines are due, do not give them — tell the crew what is due and when it was last given.

Could it be something other than a stroke?

Yes, and that is fine — call 999 anyway. Several conditions can look like a stroke. NICE recommendation 1.1.2 tells clinicians to “exclude hypoglycaemia” (low blood sugar) as a cause of sudden neurological symptoms, because a hypo can cause confusion, slurred speech and weakness.

If you work with someone who has diabetes and you are trained to check their blood glucose under their care plan, you may be asked to do so. But do not delay the 999 call to do it, and do not decide on your own that “it’s just a hypo”. Tell the call handler the person has diabetes and follow their advice.

Other conditions can also cause sudden confusion or weakness in older people, including infections and sepsis, seizures and the drowsiness that follows them (see our guide to seizure first aid), and medication side effects. Your job is not to diagnose — it is to notice a sudden change and act quickly.

How do you spot a stroke in someone with dementia or communication difficulties?

It is harder, because FAST relies on the person following instructions and speaking. Someone with advanced dementia, a learning disability or an existing speech difficulty may not be able to.

The key is the same: look for what is sudden and new for that individual. Signs that may point to a stroke include:

• new drooping on one side of the face, even when they are not asked to smile;
• suddenly not using one arm or hand they normally use — dropping a cup, not reaching for food;
• a new lean to one side in the chair, or legs that suddenly will not hold them;
• a sudden change in their usual speech or sounds;
• sudden new confusion beyond their normal pattern, or a sudden fall.

Take it seriously when family or colleagues say “she’s not right”. A good knowledge of the person — which is the heart of person-centred care — is your best tool for spotting a stroke in someone who cannot tell you. Our dementia awareness guide covers how dementia can change communication.

Who is most at risk of a stroke?

The NHS causes page says a stroke can happen to anyone at any age, but the risk may increase if a person is over 50, is from a Black or South Asian background, has sickle cell disease, has an unhealthy lifestyle or migraines, takes the combined contraceptive pill, or is pregnant with pre-eclampsia or has just had a baby. Conditions that raise the risk include high blood pressure, diabetes, atrial fibrillation (an irregular and fast heartbeat), high cholesterol and a previous TIA.

Many people you support will have several of these risk factors, so pay close attention to sudden changes. The NHS also stresses one thing care workers can directly help with: “do not forget to take medicines for any underlying conditions such as high blood pressure or diabetes”. Supporting people to take prescribed medicines as directed, and reporting missed doses, is stroke prevention in practice.

What should care workers record and hand over after a suspected stroke?

The NHS notes that if someone cannot speak after a stroke, “you may be asked for information about their symptoms”. In care, you are often the only witness. Useful things to tell the crew and record afterwards:

• Timing: when the symptoms started, or the last time the person was definitely seen well.
• What you saw: the FAST signs and any other symptoms, and whether they have changed, worsened or gone away.
• Medicines: a current medicines list. Make sure to mention blood-thinning medicines (anticoagulants). NICE recommendation 1.3.2 lists being “on anticoagulant treatment” as one reason for an immediate brain scan.
• Other conditions: diabetes, atrial fibrillation, a previous stroke or TIA, dementia, and their usual level of speech and mobility.
• What you did: the time of the 999 call, any first aid given, and any advice from the call handler.
• Wishes and plans: any advance decisions, a DNACPR form or a treatment escalation plan, so the crew can respect them.

Afterwards, complete your organisation’s incident and care records promptly and accurately.

How should you support someone after a stroke?

Recovery varies enormously. The NHS recovery page says some people recover in days or weeks, while for others “recovery can take months or years”. A home recovery plan may include physiotherapy, therapy for speech, swallowing and vision problems, and help with memory, mood and continence. The NHS says people should get a review of their progress after about six months.

NICE guideline NG236 on stroke rehabilitation includes recommendations that apply directly to care settings:

• People transferred from hospital to care homes should get stroke rehabilitation and social care “to the same standard as they would receive in their own homes” (1.1.15), with follow-up “within 72 hours by the specialist stroke rehabilitation team” (1.1.17).
• People should be encouraged to brush their teeth and gums at least twice a day, and a “suitably trained healthcare professional, family member or carer” should deliver or supervise mouth care for those who cannot manage it (1.10.2 and 1.10.3).

Day to day, that means following therapists’ plans and any texture-modified diet advice exactly, giving people time to communicate, and watching for low mood — NG236 lists the onset of depression and anxiety among things to look out for. Above all, watch for signs of a new stroke, measured against the person’s new baseline.

Do care workers have to be trained to recognise a stroke?

There is no specific law that says “care workers must complete stroke training”. But in England, the CQC’s Regulation 12 requires providers to ensure that people providing care “have the qualifications, competence, skills and experience to do so safely”, and Regulation 18 requires staff to receive “such appropriate support, training, professional development, supervision and appraisal as is necessary” for their role.

Where you support people at higher risk of stroke — which in older people’s care is most people — recognising a stroke is a reasonable part of being competent and safe. Many employers include it in first aid training or mandatory training. An online awareness course helps you recognise the signs and act quickly. It does not qualify you to carry out clinical assessments, give emergency medicines or replace practical first aid training.

Which courses cover stroke awareness?

These three £9 courses work well together for care workers, senior carers and anyone supporting older adults, each with a verifiable certificate:

• Stroke Awareness — causes, FAST and other signs, what to do in an emergency, and supporting recovery.
• Cardiovascular Disease Awareness — high blood pressure, atrial fibrillation and other conditions that raise stroke risk.
• Basic Life Support — what to do if someone collapses and stops breathing normally.

Dementia Awareness and Diabetes Awareness are useful alternatives for teams supporting people with those conditions. Any three courses cost £18 with the pay-for-2-get-3 offer — add them to the cart and the discount applies automatically. These are awareness courses: CPD accredited, but not regulated qualifications, and not a substitute for practical first aid training or clinical training.

Frequently asked questions

What are the first signs of a stroke?

The most common first signs are sudden face drooping on one side, weakness in one arm, and slurred or confused speech — the FAST signs. Other sudden signs include loss of vision, dizziness or a fall, numbness down one side, confusion and a severe headache. Call 999 if you see any one of them.

What does FAST stand for in a stroke?

Face, Arms, Speech, Time. Check whether the face has drooped, whether the person can lift both arms and keep them there, and whether their speech is slurred or confused. If any one of these is present, it is time to call 999.

Should you call 999 if stroke symptoms go away?

Yes. The NHS says to call 999 if someone has had signs of a stroke within the last 24 hours, even if they have stopped. It may be a transient ischaemic attack (TIA), which needs urgent hospital assessment and is a warning sign of a possible full stroke.

Can you give aspirin to someone having a stroke?

Not on your own initiative. Some strokes are caused by bleeding in the brain, which only a scan can rule out, and NICE recommends aspirin for acute stroke only after brain imaging has excluded a bleed. Do not give food, drink or medicines either, because swallowing may be affected.

Can a stroke happen without FAST symptoms?

Yes. FAST picks up the three most common signs, but some strokes mainly cause sudden vision loss, dizziness, unsteadiness or a fall, confusion or a severe headache. A normal FAST check does not rule out a stroke, so call 999 for any sudden, unexplained change like this.

Act FAST, every time

£9 per course. CPD accredited, 100% online, verifiable e-certificate. Pay for 2, get 3 — any 3 courses for £18.

This article is general information for care workers, not medical advice. It summarises NHS, Stroke Association and NICE guidance (NG128 and NG236) and CQC regulations as they apply in England at the time of writing; arrangements differ in Scotland, Wales and Northern Ireland. In an emergency, call 999 and follow the call handler’s instructions. Always follow your employer’s policies and the individual’s care plan. A Nexis CPD awareness course is CPD accredited but is not a regulated or clinical qualification.