By Deborah Jeanne Sergeant
Promptly treating stroke can help patients have a better chance of recovery. But that often starts with an at-home screening. The American Heart Association recommends BE FAST as a mnemonic device to easily recall the screening:
B – Balance: Sudden loss of balance, dizziness or difficulty walking can indicate a stroke affecting coordination or the cerebellum.
E – Eyes: Vision changes such as sudden loss of sight in one or both eyes or double vision are warning signs.
F – Face: Facial drooping on one side, uneven smile or numbness is a common stroke symptom.
A – Arms: Weakness or numbness in one arm or leg; if one limb drifts downward when raised, it is concerning.
S – Speech: Slurred speech, difficulty speaking or trouble understanding others signals a stroke.
T – Time: Immediate action is critical. Call 911 or emergency services without delay, as early treatment significantly improves outcomes.
The BE FAST acronym is a newer screening tool, as previously, it was only “FAST.”
“Most people are aware of FAST and aren’t aware of the ‘BE’ portion,” said Katherine Kiehle, stroke navigator nurse and performance improvement coordinator at Highland Hospital.
Of course, many people in the prime age for stroke have balance issues. However, sudden change in gait and walking is important to note. The same is true in the “E” part of “BE FAST.”
Kiehle also noted that “if anyone has sudden vision changes or loss, that is a hallmark symptom of a type of stroke. We have aging that happens to our eyes where changes happen slowly over time. If you notice a sudden, dramatic change, you need to be assessed.”
She added that with sudden neurological symptoms, it’s better to err on the side of caution and seek emergency medical care.
“About 20% of strokes happen in the back of the brain and cause changes in your balance and ability to walk or cause eyesight changes such as blurred, doubled or loss of vision,” said nurse Alice Taylor, quality assurance stroke—sepsis—STEMI coordinator for Thompson Health. “The problem with using a longer acronym is that people are less likely to remember it and be able to recall the whole thing. At this point, either tool is useful. If you compare them side by side, BE FAST covers more stroke symptoms, but FAST is more likely to be remembered.”
Taylor urges anyone experiencing what they think is a stroke or helping someone who may be having a stroke to immediately call 911.
“Patients can have an IV placed on the way, hospitals will receive pre-arrival notification from the EMS team that a stroke patient is on the way and in turn the hospital will prepare a team to meet the patient as soon as they arrive,” Taylor said. “If you think you’re having a stroke, please don’t drive yourself to the hospital.”
Angelina Wronski, registered nurse, stroke coordinator and educator at Rochester Regional Health Unity Hospital, said that mobile stroke units in Rochester can perform CT scans enroute and administer “clot busting” medication as well.
“This is a game-changer,” Wronski said. “This care begins in the field and even our regular EMS agents can get blood glucose levels and vitals.”
Calling 911 also ensures that the hospital will be ready to receive the stroke patient. After calling, have the stroke patient sit down.
“Make sure they’re in a comfortable, safe position,” Wronski said. “Make sure it’s easy for the EMS to get to them. Try not to have them walk, especially if they have a gait imbalance. Have them relax and stay seated.
“Avoid giving any fluids. At the hospital, we’ll do a swallow evaluation. Many stroke patients have dysphasia. They might have swallowing difficulties or clearing their throats which can lead to pneumonia or aspiration. It’s part of our protocol to assess for swallowing problems. This also includes medications.”
Have a list of medications available for the EMTs. Wronski said that they’ll also want to talk about when the patient was last normal and when the onset of symptoms happened.
“It can be more difficult for patients who wake up from a nap or after a 10-hour sleep,” she said. “They might be ‘out of the window’ for clot busting medication, which has to be after 4.5 after their last-known normal.”
As with any ambulance call, ensure the pets are contained to avoid escapees, tripping up the EMTs and dog bites. Clear clutter and ensure there’s a wide path to an outside door. Turn on the porch light.