FAST means don’t wait
Medicine is full of abbreviations and acronyms. Some of them come from Latin terminology, some relate to capital letters from words of commonly used phrases. There are many of these and they are not always obvious. It took me a long time to work out what to do on my first day on the wards when the senior nurse asked me to go and fetch the patient’s TTAs. To Take Aways – medications on leaving hospital. However, the most important are the mnemonics used to help clinicians remember important facts or actions. For example; ABC – airway, breathing, circulation that can be applied to the assessment of all critically ill patients – is the airway open, are they breathing, do they have a pulse? It is uncommon for these memory aids to be shared with the public but there is one that has entered our general lexicon and this is because it is so important. FAST is an easy way of remembering the symptoms of a stroke and the actions required.
A stroke or CVA (Cerebrovascular Accident) happens when the blood supply to part of the brain is cut off, killing brain cells. The effects of a stroke depend on where it takes place in the brain, and how big the damaged area is.
Ischaemic stroke is the most common type (85%) and occurs when there is a blockage to an artery either from a narrowing, from a clot, or a combination of both. The other 15% of strokes are due to bleeding in or around the brain. Both types will cause the same symptoms however they are treated differently and this is the reason for the need for speed.
The FAST acronym (Face, Arms, Speech, Time) is a test to quickly identify the three most common signs of stroke.
- Face weakness: Can the person smile? Has their mouth or eye drooped?
- Arm weakness: Can the person raise both arms fully and keep them there?
- Speech problems: Can the person speak clearly and understand what you say? Is their speech slurred? Are they speaking in clear sentences? Are they having difficulty finding words?
- Time to call 999: if you see any one of these signs.
There are other symptoms of stroke; any sudden loss of sight, power in any limb, balance or memory should be taken seriously – call 999.
If patients get to the hospital within 3 hours of the first symptoms of an ischemic stroke, they may get a type of medicine called a thrombolytic (a “clot-busting” drug) to break up blood clots. Quickly removing the cause of the stroke massively increases the chances of a full recovery. Paramedic crews prioritise patients who might have had an ischaemic stroke as there is a critical timeframe to give a life changing treatment.
We now see far fewer patients suffering strokes than when I qualified. This is mainly due to a significant reduction in the threshold for starting blood pressure treatment and that fewer patients are smoking. While most people who have a stroke are older, younger people can have strokes too. One in four strokes in the UK happens to people of working age. So, if you are with someone who suddenly develops any of the symptoms that I have described, act FAST, don’t wait, dial 999.
Anthony O’Brien, Wyndham House Surgery
(Parish Magazine article March 2025)