Key Takeaways
- A new facial droop, one-sided arm or leg weakness, speech problem, sudden loss of balance or vision may be a stroke. Treat one sign as enough to call emergency services.
- In mainland China, call 120. Do not drive, take a taxi to a preferred distant hospital, return to the hotel or continue to the airport.
- Record the last-known-well time: the last moment the person was definitely normal. It is not always the time the symptoms were discovered.
- Do not give aspirin, blood-pressure tablets, food or drink unless emergency professionals specifically instruct you. A scan is needed to distinguish a blocked artery from bleeding in the brain.
- Symptoms that improve or disappear can be a transient ischemic attack (TIA) and still require immediate assessment.
- Passports and medical records help, but the companion should collect only what is immediately available. Never delay the emergency call to find documents.
Content
Stroke rarely announces itself with a neat label. At a hotel breakfast, a traveler may drop a cup. At an airport, a companion may notice an uneven smile or suddenly garbled words. Someone who wakes from a nap may be unable to move one arm but insist on waiting to see whether it passes.
That is the decision point. Stop the journey and start local emergency care.
Use BE-FAST: one sudden sign is enough
BE-FAST is a memory aid, not a test the patient must complete:
- B — Balance: sudden dizziness, stumbling, loss of balance or coordination;
- E — Eyes: sudden blurred, double or lost vision in one or both eyes;
- F — Face: one side droops or the smile becomes uneven;
- A — Arms: one arm drifts down, or a limb becomes suddenly weak or numb;
- S — Speech: speech is slurred, words do not make sense, or the person cannot speak or understand normally;
- T — Time: call emergency services immediately and preserve the timeline.
Other warnings include sudden confusion, numbness or weakness on one side, trouble walking, or a sudden severe headache with no known cause. CDC guidance advises calling an ambulance rather than driving and says to note when symptoms first appeared [1]. China’s National Health Commission promotes both BE-FAST and the Chinese “Stroke 120” recognition method [4].
Do not wait for several signs. A single new, sudden neurologic deficit is enough to act.
The most useful time may be “last known well”
Emergency teams will ask when the person was last definitely at their usual neurologic baseline. This last-known-well time can differ from the discovery time.
- If speech changed while ordering breakfast at 08:20, both times may be close.
- If the person woke at 07:00 unable to move an arm but was normal at bedtime at 23:00, the last-known-well time is 23:00—not 07:00.
- If a passenger seemed normal before a two-hour nap and was confused on waking, record the last normal conversation and the wake-up discovery separately.
Write both times down. If uncertain, say so; do not invent precision. Tell responders whether onset was witnessed, symptoms fluctuated, or the patient woke with them. Emergency assessment may begin in the ambulance, and the timing helps the stroke team choose imaging and treatment pathways [2].
What the companion should do in the first five minutes
- Call emergency services. In mainland China, dial 120. State “possible stroke,” the exact location, floor, room, gate or carriage, and whether the patient is conscious and breathing.
- Note time and signs. Record last known well, discovery time and the first symptom noticed. A short phone video of the abnormal face, arm or speech may help if symptoms resolve, but never delay the call or compromise privacy unnecessarily.
- Keep the patient safe. Stop walking. Help them sit or lie somewhere protected. If drowsy or vomiting, follow dispatcher instructions about positioning and airway safety.
- Do not give anything by mouth. Swallowing may be impaired. Do not offer water, food, sugar drinks or tablets.
- Prepare a brief handover. If immediately available, take the medicine list, allergies, anticoagulant name and last dose, recent procedures, passport/ID and emergency contact. Send someone else to meet the ambulance.
China’s National Health Commission advises against shaking or lifting the person unnecessarily and against giving food, sugar water or medicines while waiting, because vomiting, aspiration or an unrecognized brain hemorrhage may make those actions harmful [5].
Why aspirin and extra blood-pressure medicine are unsafe guesses
A stroke can result from a blocked vessel or a bleeding vessel. The symptoms can look similar, but treatment is different. Brain imaging and clinical assessment are used to identify the type; thrombolytic medicine intended for an ischemic stroke can worsen bleeding [2][3].
For the same reason, do not give aspirin “just in case.” China’s National Health Commission warns that self-administered aspirin may increase bleeding if the stroke is hemorrhagic [5][7]. Do not use someone else’s medicine, double an antihypertensive dose or try to force the blood pressure down. Tell the emergency team what the patient normally takes and any dose already taken.
If the dispatcher or treating clinician gives a specific instruction, follow it. The rule is not “never use medicine”; it is “do not choose stroke treatment before professionals have identified the problem.”
Do not let temporary improvement restart the trip
Face, arm or speech symptoms may disappear within minutes. That can be a TIA—a warning event that still needs immediate medical attention. CDC advises calling emergency services even when symptoms go away [1].
Do not check out of the emergency pathway because the smile looks normal again. Do not board a flight, sleep it off or wait for the overseas hospital to open. Tell the team exactly which symptoms resolved and when.
Low blood glucose, seizure, migraine and other conditions can resemble stroke. That possibility should not be used to self-dismiss a sudden deficit. Emergency clinicians can check glucose and perform the necessary examination and imaging. If the patient has diabetes and a reading is immediately available, report it to dispatch; do not delay the ambulance while searching for a device.
Travel setting changes the logistics, not the urgency
Hotel: call 120 first, then ask reception to direct responders to the room and hold an elevator. Keep the door unlocked. Do not take the patient to the lobby if movement is unsafe.
Airport or railway station: alert staff and give the terminal, gate, platform or landmark. Do not continue through security or walk toward a clinic at the far side of the building unless emergency personnel direct it.
Aircraft: tell cabin crew immediately and use the words “possible stroke” and the last-known-well time. Crew can contact medical support and arrange priority reception or diversion. Do not hide symptoms to preserve a connection.
Train: notify crew, state the carriage and seat, and ask them to coordinate emergency reception at the safest stop. Do not decide alone to remain onboard until the planned destination.
Give a 20-second handover
A useful opening is:
“This is a -year-old traveler. They were last known well at . At we noticed sudden on the right/left side. The symptoms are continuing/improving. They take , including the blood thinner ; the last dose was . We are at .”
Add recent surgery, bleeding, head injury, prior stroke, seizure, diabetes, pregnancy/postpartum status and major allergies. If language is difficult, show the times and medicine names on the phone. Keep original medication packaging when practical.
Treatment is imaging- and eligibility-dependent
Stroke treatment is not a countdown that authorizes self-treatment. Selected patients with ischemic stroke may be eligible for intravenous thrombolysis within a limited window, often up to 4.5 hours, while selected large-vessel occlusions may be considered for thrombectomy later—sometimes 6 to 24 hours—after imaging and specialist assessment [6]. These figures explain why speed matters; they do not predict an individual’s eligibility.
The receiving team may perform neurologic examination, glucose testing, CT or other imaging and vascular studies. NINDS notes that distinguishing ischemic from hemorrhagic stroke is essential because their treatments differ [2]. Use the nearest appropriate emergency route; let emergency systems determine the stroke-capable destination.
After stabilization, rebuild the travel plan around medical clearance
Before leaving care, obtain the emergency summary, imaging reports and files, laboratory results, medication changes, warning signs, rehabilitation or swallowing advice and a named follow-up contact. Ask:
- What diagnosis was made, and what remains uncertain?
- What would require immediate return?
- Is the patient safe to fly or take a long train journey, and on what date?
- Is mobility assistance, oxygen, a companion or airline medical clearance needed?
- Which clinician will review the patient at the destination or home?
Do not use a missed booking as the reason to abbreviate observation or rehabilitation planning. A stroke pathway begins locally; onward medical travel can be reconsidered only after the treating team says it is safe.
Medical disclaimer: This guide provides general education, not diagnosis or individualized treatment. Sudden neurologic symptoms are an emergency. Call local emergency services immediately rather than waiting for an international medical arrangement.
FAQ
What if only the face droops and the arm seems normal?
One sudden focal sign is enough to suspect stroke. Call emergency services, note the last-known-well time and do not wait for another BE-FAST sign to appear.
Should I drive the patient to the hospital I originally selected?
No. Call an ambulance. The patient can deteriorate in transit, and emergency teams can assess, monitor and route them to an appropriate stroke-capable facility. A distant preferred hospital should not create a detour.
Can I give aspirin while waiting for 120?
Not unless emergency professionals specifically instruct you. Stroke may be caused by bleeding, and aspirin can increase bleeding. Imaging and assessment must guide treatment.
What if the symptoms disappear before the ambulance arrives?
Continue with emergency assessment. A TIA can resolve quickly but may warn of a major stroke. Tell responders what happened, which side was affected and the exact times.
Is the onset time when the patient woke up with weakness?
The discovery time is when weakness was noticed. The last-known-well time is the last time the person was definitely normal—often bedtime or the last normal interaction. Give both to the team.
Sources
- US Centers for Disease Control and Prevention: Signs and Symptoms of Stroke
- US National Institute of Neurological Disorders and Stroke: Assess and Treat
- US National Institute of Neurological Disorders and Stroke: Stroke Overview
- National Health Commission of China: World Stroke Day 2023—BE-FAST and Stroke 120
- National Health Commission of China: What to Do While Waiting for Stroke Emergency Care
- National Health Commission of China: World Stroke Day 2025—Recognition and Reperfusion Windows
- National Health Commission of China: Speech Warning Signs and Why Not to Self-Administer Aspirin