BEFAST: How to Identify Stroke Symptoms and Warning Signs

Would you be able to recognize symptoms of a stroke in a friend or loved one? Do you know what to do if you or someone around you is experiencing a stroke?

“It is vitally important to be able to recognize the signs that you or someone you are with may be having a stroke. Better stroke outcomes begin with stroke recognition and calling 911 immediately. You need to act quickly because the longer you wait to get care, the more damage occurs to your brain cells,” says Heydi Flores Podadera, MD, of the Department of Neurology at Baystate Health.

And if the person experiencing symptoms insists they are fine or want to wait a bit to see if symptoms subside?

“Don’t listen to them and don’t waste time for the symptoms to go away. Stroke is serious and every second counts. Call 911, don’t drive them to the hospital. Stroke care begins in the ambulance. EMT’s alert the hospital so the emergency department, stroke team, radiology, and pharmacy are at the door to treat the patient coming in,” says Stephanie Winslow, a stroke coordinator in the Stroke Program at Baystate Medical Center.

What is Stroke?

A stroke happens when part of the brain has a sudden disruption in its blood supply. The lack of blood flow means that part of the brain doesn’t receive its necessary oxygen and nutrients, and brain tissue dies as a result. Most strokes happen because a blood clot blocks an artery or a blood vessel in the brain or neck breaks.

This is why time is critical and calling 911 is the proper response to stroke symptoms - brain tissue is dying while you wait to get yourself or your loved one medical attention.

How to Recognize Stroke Symptoms - BEFAST

The acronym BEFAST helps to identify the signs and symptoms of stroke and at the same time admonishes you to “be fast” and not wait to get help.

• Balance means a sudden loss of balance
• Eyes mean a loss of vision in one or both eyes
• Face means uneven like a crooked smile or numbness
• Arm (or leg, too) means it is hanging down and can’t be held up straight
• Speech means it may be slurred or the person may have trouble speaking or seem confused about what you are saying or they are talking nonsense
• Time is calling 911 immediately

In more detail, major warning signs of a stroke are:

• Numbness or weakness on one side of the body – a drooping face or arm that falls when you lift it up. These symptoms can also apply to the spine, legs and feet.
• Sudden severe headache
• Blurry vision, loss of peripheral vision, or total loss of vision in one or both eyes
• Feeling abnormally confused
• Problems communicating, which could include slurred speech or the inability to understand what someone is saying to you
• Sudden trouble walking, dizziness, loss of balance, or lack of coordination

“While migraines can cause blurred vision or headaches, remember that in the case of a stroke, you’re looking for sudden onset of symptoms, or a sudden severe headache,” says Rachel Paciorek, a stroke coordinator in the Stroke Program at Baystate Medical Center.

While women and men share a common set of stroke and heart attack symptoms, signs of stroke in women may also include nausea or vomiting, general weakness and fainting spells, shortness of breath, sudden non-stop hiccups, and extreme tiredness with the onset of a stroke.

Call 911 for Signs of Stroke

“Some people are afraid to activate the emergency response system for fear of bothering them. I can’t emphasize enough how it is so important not to wait before calling 911 because there are treatments that can be given if the patient reaches the hospital in time,” Winslow says.

The risk of disability decreases if clot-busting drugs are administered within 4.5 hours, according to guidelines from the American Heart Association (AHA) and American Stroke Association (ASA). These guidelines also state that mechanical clot removals can be performed up to 24 hours after the start of stroke symptoms.

While Waiting for the Ambulance to Arrive

After calling 911, you can help keep a person experiencing stroke symptoms safe while you wait for emergency services to arrive.

Note the time you first noticed stroke symptoms. Even if the symptoms started before you began to assist them, it is helpful information for doctors to determine the appropriate treatment from administering clot-busting drugs to performing a thrombectomy to remove the clot. “You also do not want to give the person anything to eat or drink for fear of choking if they are having trouble swallowing. Also, do not give them any medications, especially aspirin, because if they are suffering a brain bleed the aspirin could put them at greater risk,” Winslow says.

Check to see if the person is breathing or has a pulse and perform CPR if needed. Ask the 911 operator for guidance if you don’t know how to administer the procedure.

Have the person lie on their side with their head elevated. Having them lie on their side promotes blood flow to the brain. But be sure not to move them if they have fallen. Keep the person comfortable by loosening restrictive clothing that might deter breathing and keep them warm with a blanket if available.

Remain with the person to comfort them and assure them that help is on the way. Continue to monitor their symptoms and let the paramedics know of any changes since you arrived on the scene.

If they are verbal, attempt to get any information possible in advance for the paramedics such as allergies, medications they are taking, and any chronic medical conditions they may have.

Remember - BEFAST, Call 911

Fast evaluation and medical intervention during stroke saves lives and makes treatment and rehabilitation more effective. Don't hesitate. Call 911 at first signs of a stroke.