Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
Learning the signs and symptoms of stroke and how to respond to a stroke emergency is not something to put off until old age. While more than two-thirds of strokes occur in people over age 65, the rate of stroke among young people is rising alarmingly, thanks to risk factors like obesity, high blood pressure, and diabetes affecting younger and younger populations. The scary truth is that a stroke occurs every 40 seconds in the United States, and the next victim could be the person sitting across from you on the bus, the waiter carrying food to your table, or your grandson’s soccer coach in the middle of a game. Recognizing the signs of stroke and knowing how to respond could make the difference between life and death, or between a full recovery and lifelong disability, for the person you help.
The first hurdle, of course, is recognizing that what you’re seeing is a stroke. The classic stroke symptoms are drooping facial muscles on one side, loss of muscular control in the limbs, and speech impairment. Experts have developed a mnemonic to help you remember a quick three-point checklist as you assess a person in an effort to determine whether they’re having a stroke. The mnemonic is FAST, for “Face, Arms, Speech, Time.”
For each of the first three of these—Face, Arms, and Speech—present the person with a small challenge and note the result. They are:
Face: Ask the person to smile at you. Does their face droop on one side? You may be able to detect a facial droop without performing this test, but having the person smile will make any asymmetry much easier to see.
Arms: Ask him or her to lift their hands over their head. Are they unable to raise one or both arms? If so, they may be having a stroke.
Speech: Ask the person to repeat a simple sentence back to you. Don’t worry too much about finding the perfect sentence. It doesn’t need to contain “gotchas” or tongue-twisters to tell you what you need to know. If you can’t think of anything offhand, just look around at your surroundings and ask the person to repeat back to you some simple observation, such as, “All the tables in here have white tablecloths,” or, “This park has a duck pond in it.” Does the person have trouble saying the sentence back to you? “Trouble” in this case could mean a few different things. They might leave out one or more words. They might not be able to remember the whole sentence. They might significantly change the sentence. They might slur their speech. They might even be completely unable to say a word.
If the person has “failed” one or more of these three tests, the fourth item in the FAST mnemonic comes into play. “Time” is of the essence. The more time that elapses between the onset of the stroke and efforts to prevent permanent damage, the less likely that those efforts will succeed. So run through this list very quickly and then immediately dial 9-1-1—don’t delay.
The Face, Arms, and Speech signs are not the only indications of stroke, nor do they appear in all cases (although it’s estimated that FAST covers 75% of stroke signs). Problems with balance and with vision are common enough that some experts suggest amending the mnemonic to BE FAST, with the B for “Balance” problems and the E for blurred or double vision in the “Eyes.” Other possible signs include extreme headache, nausea, weakness, and fatigue.
Step one…call 911. Because time is crucial, you should immediately call 911 and report that you think someone is having a stroke. In most cases, it’s preferable that you let the person ride to the hospital in an ambulance rather than driving them there in your car. That’s because the paramedics will take the person to where they can get the best stroke care, which is a stroke center if there’s one in your vicinity. They may also be able to begin treatment in the ambulance to stave off the worst outcomes. And they will call ahead to the ER so that preparations can be made there to begin treatment immediately upon arrival. Stay on the phone with the 911 operator until the ambulance arrives.
Step two…See to the person’s well-being. Make sure the person is not in any physical danger from things like traffic, harsh sunlight, cold weather, etcetera. If the person is conscious, make them comfortable by having them lie down on their side with their head slightly tilted. Loosen up their clothing, especially any garment that might restrict their breathing. Talk to them, keeping careful note of how responsive they are.
If the person is unconscious, lay them on their side with the bottom leg straight and the top leg bent at the knee. Make sure their head is tilted forward. Check their breathing and pulse, beginning by clearing their airway with your finger if necessary. If the person is not breathing, begin CPR. If you don’t know CPR, the operator should be able to guide you through it.
Whether the person is conscious or not, check them for any signs of bleeding from a fall. If you do see bleeding, stop it with direct pressure. Do not give him or her anything to eat or drink.
Step three…Write everything down. While you’re waiting for the ambulance, make a note of what time the first signs of stroke appeared and what those signs were. Having a clear record of the event will help doctors better understand the stroke and will help guide them toward certain treatments.
Step four…gather what you can. If the person is responsive, ask if they have a list of their current medications, either on paper or in their phone. Gather up their ID, insurance card, and any other documentation you think they’ll need at the hospital.
If you can, accompany them to the hospital or call another family member or friend. The person having the stroke will greatly appreciate having someone by their side and not going through it alone.
