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FAST is important, but now it’s important to BE FAST

September 24, 2020
Published in: Stroke

Older woman touching her temples while looking into a mirror

When it comes to recognizing and treating Stroke, FAST has always been important. For years, health educators and stroke experts have used the acronym FAST (Face-Arms-Speech-Time) to help people identify stroke symptoms and those having a stroke. Recently, though, the acronym has been tweaked to BE FAST. Balance loss and Eyesight are the two additional symptoms that have been added to acronym.

And it's not just change for changes sake: there's much research behind the addition.

"Research studies were done, retrospectively, on patients who had experienced a stroke," says Amy Markham, MSN, RN, SCRN, and Coordinator for Augusta Health's Stroke Team. "The FAST acronym was very successful in identifying the most common types of stroke. The back part of the brain, though, is responsible for balance and eyesight, and those strokes were being missed in the acronym. Adding the B and the E will help all of us recognize strokes occurring in that part of the brain."

According to the study, done at the University of Kentucky Stroke Center, about 14% of stroke patients did not have the symptoms covered in the FAST acronym. Adding BE to FAST reduced the proportion to 4.4%.

Patients experiencing a posterior stroke, the strokes in the back of the brain, may be off balance, have trouble walking or have sudden loss of vision in one or both eyes. Facial droop and arm weakness, the F and the A, are common sign of an anterior, or front of the brain stroke. BE FAST is needed to cover both options.

"We always say, 'Time is brain'," adds Markham, "so I want to emphasize the importance of the "T" in the acronym. It's for Time, or Time to call 911. According to the American Heart/Stroke Association, every minute that goes by with no treatment, 1.9 million neurons, brain cells, are being lost. "Time is critical because the treatments we can provide to lessen the impact of a stroke, such as the clot-busting drug known as t-PA (Alteplase), are time sensitive. It really does matter how quickly you seek care. We only have a few hours to work with. So if adding "BE" to the acronym can help us identify 10% more stroke patients quickly, it's an easy change."

BEFAST illustration
Source: Duke Health

Markham also mentions that compared to other emergencies, such as a heart attack, strokes are relatively painless. There isn't crushing chest pain or the inability to breathe. Perhaps just blurred vision or arm weakness, so patients often lay down and rest, hoping that the symptoms will just go away and they'll feel better.

"But a stroke is just as serious as a heart attack. It's one of the leading cause of death in our area and THE leading cause of disability," says Markham. "So know the symptoms, BE FAST, and call 911 to seek care as quickly as possible."