New Stroke Symptom Acronym Says 'BE FAST' About Calling 911

Jeri Ward was only 30 years old when she experienced a stroke that left her unable to move or talk and nearly took her life. A busy social worker and community advocate, Ward initially attributed her symptoms to the stress of her job. But when she lost her ability to speak and could not tell her husband something was wrong, she knew it was time to go to the hospital.

Ward had identified a key tenant of stroke warning signs: speech difficulty.

Sure enough, Ward was having a stroke, and ultimately required a year of rehabilitation to regain speech and mobility. That was five years ago. Now, she works as a stroke educator, advocating for better stroke awareness and protocols.

May is National Stroke Awareness Month, a time to learn the most common signs of stroke and the importance of getting care even faster than Ward did. You may be familiar with the acronym FAST, a mnemonic device that’s been used by the American Heart Association and the American Stroke Association since 1998 to cover the major stroke symptoms in the front of the brain (if you’re experiencing facial drooping, arm weakness, and/or speech difficulties, it’s time to call 911). But this year, the Society of NeuroInterventional Surgery (SNIS) doesn't just want you to know FAST, it wants you to BE FAST when responding to a stroke by looking for:

• Balance difficulties
• Eyesight changes
• Facial drooping
• Arm weakness
• Speech difficulties
• Time to call 911

SNIS emphasizes the addition BE (balance and eyesight) to encompass stroke symptoms in the back of the brain, which are less common but still prevalent.

The organization’s Get Ahead of Stroke campaign also emphasizes the importance of calling 911 as soon as possible during a stroke, since immediate care can make the difference between full recovery and permanent disability.

“We want to make sure that patients and the people that shape our communities, like emergency responders and lawmakers, realize the incredible importance of identifying a stroke early and getting patients to a center that can treat their stroke right away,” J Mocco, MD, a neurosurgeon with Mount Sinai in New York, NY, and a spokesperson for the Get Ahead of Stroke campaign, told Verywell.

Additional Stroke Warning Signs

Stroke symptoms will vary depending on the brain area the stroke impacts. BE-FAST does not encompass all potential stroke signs, but it does include the majority of symptoms that could point to stroke.

Other stroke signs include:

• Numbness
  
• Weakness
• Difficulty walking
• Briefly losing vision in one of your eyes
• Dizziness
• Confusion
• Tingling

A sudden, severe headache, often described by patients as “the worst headache of their life,” can indicate a hemorrhagic stroke and needs immediate evaluation. If in doubt, seek emergency medical care.

Why It’s Important to Literally ‘Be Fast’ During Stroke Response

All cells in the body must have oxygen to function and survive, and a lack of oxygen is the most immediate and dire threat to life. While all organs in your body will quickly feel the effects of decreased oxygen, the brain is the most sensitive organ to this threat.

“The brain has a very low tolerance for not receiving the blood flow and oxygen it needs, so it tends to die very early,” Edward C. Jauch, MD, chair of the department of research at University of North Carolina Health Sciences at MAHEC, told Verywell. “The window of opportunity to save dying brain tissue is narrower than other organs, such as the heart.”

Halting a stroke and restoring blood flow in the brain is paramount to preventing disability.

“Someone having an ischemic stroke loses about two million brain cells every minute,” Mocco said. “If we restore the blood flow, they might have no permanent effects. Patients who receive proper treatment within 90 minutes of being diagnosed with a stroke are 90% likely to return to being independent. However, if treatment is after three hours, their likelihood of returning to being independent drops to 20-25%.”

When a patient enters to the emergency room with signs of a stroke, they should receive a CT scan of the brain within 15 minutes of arrival to determine which type of stroke they are having and to rule out other possible causes for their symptoms.

Calling an Ambulance Could Make or Break Stroke Treatment

In the event of a stroke, you might think it would be quickest to take your loved one to the hospital yourself, but experts advise calling 911. Having an ambulance transport the patient is the best course of action because first responders should know which hospitals in the area are certified stroke centers. They can often notify the hospital of a patient’s pending arrival, saving valuable time.

“When in doubt, call 911. Calling 911 increases your chances of getting to the right hospital and getting the right treatment as quickly as possible,” said Jauch.

Not all hospitals are fully equipped to provide gold-standard stroke care. Arriving at a hospital that is not stroke-certified can delay proper treatment.

The Centers for Medicare and Medicaid has appointed four organizations, including The Joint Commission, to certify hospitals as stroke centers. This designation means they have proven they have the resources to treat strokes to the highest level of care. There are three levels of stroke center designations:

• Level 1 stroke centers, or comprehensive stroke centers, offer the full spectrum of state-of-the-art stroke care. They have stroke teams in-house 24/7 to respond to and treat stroke patients. A Level 1 stroke center must treat at least 250 stroke patients annually, perform at least 50 thrombectomies yearly, and have designated inpatient units for stroke patients.
• If there is no Level 1 stroke center within 2 hours, a patient may be transferred to a Level 2 stroke center. Level 2 stroke centers must treat 100 stroke patients and perform 50 thrombectomies a year to maintain their certification, and they also must have a dedicated inpatient stroke care unit.
• Level 3 stroke centers are the lowest level of stroke certification for patients not within 2 hours of a Level 1 or 2 stroke center hospital. They must treat at least 50 stroke patients annually and have a dedicated inpatient stroke care unit. On-site neurosurgical services are optional for Level 3 stroke centers, so they may or may not be able to perform thrombectomies.

Some states have policies and regulations ensuring EMS providers take stroke patients to stroke-certified hospitals, even if that means bypassing another hospital. However, there is still a lot of progress to be made. The Get Ahead of Stroke campaign is working with lawmakers and emergency services in states that do not have the processes to guide and streamline stroke care.

“We want to make sure that stroke patients are getting quick and timely treatment by being brought to the right place every time,” said Mocco.

How to Reduce Your Risk Factors for Stroke

There are some stroke risk factors you cannot control, including your genetics and your age. Atrial fibrillation, an abnormal, irregular heart rhythm, can cause clots to form in the heart, increasing the risk of stroke five-fold. Individuals with atrial fibrillation should see a cardiologist to monitor their condition and often need anticoagulants to reduce their risk of stroke.

However, there are many stroke risk factors you can control. Smoking damages blood vessels and increases your risk of stroke. If you have high blood pressure, high cholesterol, or diabetes, work with your primary care provider to manage these conditions. Getting regular exercise and managing your stress are other measures you can take to reduce your stroke risk.

“It’s never too late for primary prevention,” Jauch said. Even small steps can have a significant impact. “If we can manage modifiable lifestyle factors, we cut stroke risk in half.”