Know the Signs of Stroke: B.E. F.A.S.T. and Why Minutes Matter

The Centers for Disease Control and Prevention (CDC) explains that a stroke, sometimes called a brain attack, “occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts.” There are two main types:

• Ischemic stroke: blood clots or other particles block the blood vessels to the brain.
• Hemorrhagic stroke: an artery in the brain leaks blood or ruptures (breaks open).

Either way, the CDC notes that brain cells start to die within minutes because they can’t get oxygen. That is why stroke is always an emergency.

The American Heart Association promotes F.A.S.T.: Face drooping, Arm weakness, Speech difficulty, Time to call 911. The expanded B.E. F.A.S.T. adds balance loss and eye (vision) changes. The CDC describes the checks this way:

• B – Balance loss: Ask the person if they are feeling off-balance or dizzy.
• E – Eye (vision) changes: Ask the person if they have trouble seeing normally.
• F – Face: Ask the person to smile. Does one side of the face droop?
• A – Arms: Ask the person to raise both arms. Does one arm drift downward?
• S – Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?
• T – Time: If you see any of these signs, call 911 right away.

Other sudden warning signs

The CDC also lists these signs of stroke in both men and women. The key word is sudden:

• Sudden numbness or weakness in the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or difficulty understanding speech
• Sudden trouble seeing
• Sudden trouble walking, dizziness, loss of balance or lack of coordination
• Sudden severe headache with no known cause

It can feel faster to load someone into the car. The CDC advises against it: “Do not drive to the hospital or let someone else drive you. Call 9-1-1 for an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.”

Calling 911 also lets EMS crews alert the hospital before you arrive. A review of prehospital stroke care published in the Western Journal of Emergency Medicine found that higher dispatch priority and hospital notification of a stroke were both linked to shorter times from the ambulance call to arrival.

The CDC recommends that you “note the time when any symptoms first appear,” because this information helps health care providers determine the best treatment. Some stroke treatments can only be given within a limited window of time.

Sometimes no one saw the symptoms begin, such as when a person wakes up with them or is found alone. In that case, be ready to tell responders the last time the person was known to be normal. Emergency medical guidance calls this the “last seen normal” or “last known well” time, and responders work to document it.

• Check a clock or your phone as soon as you notice symptoms.
• If you were not there when symptoms started, think about when the person was last seen acting like themselves.
• Share this time with the 911 dispatcher and the EMS crew.
• Stay with the person and follow the dispatcher’s instructions until help arrives.

A transient ischemic attack (TIA) happens when blood flow to the brain is blocked for only a short time. The CDC says this is usually no more than 5 minutes, and that “a TIA is a warning sign of a future stroke.” Because you cannot tell in the moment whether symptoms will pass, treat every sign of stroke as an emergency and call 911.

This article is general education, not personal medical advice. Talk with your health care provider about your own stroke risk.

Republic EMS, Ltd. is a licensed Texas EMS provider whose crews include a Paramedic and an EMT on every unit, serving Greater Houston, Dallas, San Antonio, Corpus Christi, Beaumont and surrounding areas. Learning B.E. F.A.S.T. takes a minute and could make a lifelong difference for someone you love.