BEFAST: Do you know what to do when seconds count?

March 30, 2023

A woman checks another woman for signs of stroke

What’s the first thing someone usually tells you if they appear to be having a heart attack or stroke and you want to call the ambulance to help them?

“No, I think it’s probably nothing and I’ll be better in a few moments.”

Here’s a good piece of advice during National Stroke Awareness Month from nurse Stephanie Winslow, stroke coordinator in the Stroke Program at Baystate Medical Center, that you can keep with you forever.

“Don’t listen to them and don’t waste time for the symptoms to go away. Stroke is a serious medical emergency and you need to call 911 right away. Never drive the person to the Emergency Department because EMTs can begin life-saving treatment on the way to a designated stroke center like that found at Baystate, which is especially equipped with a stroke team to meet the patient upon arrival at the hospital,” says Winslow.

Learn the BEFAST Acronym

“‘Time is brain’ as the saying goes and every second that passes without getting treatment means the death of more brain cells resulting in a poorer outcome and greater permanent brain damage,” she adds.

Public knowledge of stroke symptoms is poor, and that is why it is so important to be able to spot the signs of a stroke and know what to do to possibly save a person’s life and prevent long-term disability.

“We are trying to educate the community about the acronym BEFAST, which 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. B stands for balance, E is for eyes, F means face, A identifies arm, S stands for speech and T means time is of the essence,” says Winslow.

Further translating the BEFAST stroke acronym into signs and symptoms:

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.

Don’t wait to call 911

“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.

“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.

Do’s and don'ts

Additional “do’s and don’ts if someone is having a stroke include:

DO note the time when you first noticed the person’s 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.

DO 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.

DO 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.

DON'T let the person convince you to 'wait and see.'

Sometimes, a loved one will tell you that if they fall asleep and wake up everything will be okay. It is better to take action.

Winslow also emphasizes the importance of remaining calm in what can be a very scary moment for someone to come upon a loved one, friend or stranger “whose eyes may be off to one side and who is not responding to you.”

“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. And, 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,” says Winslow.