Stroke recognition uses FAST: face drooping, arm weakness, speech difficulty, time to call emergency services. Treatment is time limited, so the single most valuable thing a bystander does is note when symptoms started and get the person to hospital immediately.
Stroke recognition with FAST
A stroke is a loss of blood supply to part of the brain, either from a blockage or from bleeding. Brain tissue starts dying quickly, which is why every element of the response is about speed.
F, face. Ask them to smile. Does one side droop or fail to move?
A, arms. Ask them to raise both arms and hold them up. Does one drift down or fail to rise?
S, speech. Ask them to repeat a simple sentence. Is it slurred, jumbled, or are they unable to find words?
T, time. If any of these are present, call emergency services immediately and note the time symptoms began.
Any one of the three is enough. You do not need all three, and you should not spend time repeating the test to be sure.
What FAST misses
FAST is deliberately simple and it catches most strokes. It does not catch all of them, and these presentations are frequently dismissed.
- Sudden numbness or weakness on one side of the body, including the leg
- Sudden confusion or trouble understanding what is said
- Sudden vision loss or double vision in one or both eyes
- Sudden severe dizziness, loss of balance or coordination
- A sudden severe headache with no known cause, sometimes described as the worst of the person’s life
The word that runs through all of these is sudden. Symptoms that appear abruptly are the ones that suggest stroke.
Why the time of onset matters
Treatments for the commonest kind of stroke work within a limited window measured in hours from when symptoms began. Outside that window the options narrow considerably.
So the most valuable piece of information a bystander can supply is when the person was last seen completely normal. Not when somebody noticed, but when they were definitely fine.
This matters especially for someone who wakes with symptoms, where the relevant time is when they went to bed, not when they woke. Tell the ambulance crew that clearly.
What to do
- Call emergency services immediately. Do not drive them yourself unless you have no alternative, since the ambulance can pre alert the hospital.
- Note the time symptoms started, or when they were last seen normal.
- Keep them calm, still and comfortable. Lying with the head slightly raised is usual.
- If they are unresponsive but breathing, use the recovery position with the affected side down.
- Monitor breathing continuously and be ready to begin resuscitation.
- Note any medications they take, particularly blood thinners, which changes hospital treatment.
- Stay with them and keep talking to them, even if they cannot answer. People frequently understand more than they can express.
What not to do
- Do not give food, drink or medication. Swallowing is often impaired and aspiration is a real risk.
- Do not give aspirin. It helps one kind of stroke and is dangerous in the other, and you cannot tell which without a scan.
- Do not let them lie down and sleep it off, which is a common and costly decision.
- Do not wait to see whether it improves.
Symptoms that go away
Sometimes symptoms resolve within minutes. That is a transient ischaemic attack, and it is a warning rather than a false alarm.
A substantial proportion of people who have one go on to have a full stroke soon afterwards, often within days. Anybody whose stroke symptoms resolve still needs urgent medical assessment the same day, and they will frequently argue about it because they feel fine.
Stroke is not only an older person's condition
Most strokes happen to older adults, and a meaningful number happen to people in their thirties, forties and fifties, and occasionally to children.
Age is the reason bystanders most often dismiss the signs. If a thirty year old has sudden face droop and slurred speech, apply FAST and call, rather than concluding they must be intoxicated or tired.
For facilities
Include stroke in staff first aid training and in your emergency action plan. At an aquatic facility the specific risk is a swimmer or a spectator on the deck, and the specific hazard is that early signs, unsteady movement, confusion, difficulty speaking, look like a swimmer who is simply exhausted.
Guards who notice a swimmer becoming unsteady or unresponsive should get them out of the water first and assess afterwards, since a stroke in water becomes a drowning very quickly.
Reducing the risk
Stroke is not purely a matter of luck, and the main contributors are well established: high blood pressure, which is the single largest, along with smoking, diabetes, high cholesterol, atrial fibrillation, physical inactivity, obesity and heavy alcohol use.
Most of those are modifiable, and high blood pressure in particular is common, symptomless and easy to check. It is worth saying plainly because a good deal of stroke prevention happens years before the emergency, in a routine appointment rather than at a poolside.
Waiting for the ambulance
Have somebody meet the crew and bring them directly to the person. Have the time of onset, the person’s medications and any known conditions ready to hand over. That handover takes seconds and saves the crew minutes at the moment minutes matter most.
Frequently asked questions
What does FAST mean in stroke recognition?
Face drooping, arm weakness, speech difficulty, time to call. Stroke recognition needs only one of the three signs before you call emergency services.
Why does the time of onset matter in stroke recognition?
Because treatment is time limited. Stroke recognition should record when the person was last seen completely normal, which for someone who woke with symptoms is bedtime.
Should stroke recognition lead me to give aspirin?
No. Stroke recognition cannot distinguish a clot from a bleed without a scan, and aspirin is dangerous in the second kind.
What if symptoms vanish after stroke recognition signs appear?
Still seek urgent care that day. In stroke recognition terms that is a transient ischaemic attack, a warning that a full stroke may follow within days.