Stroke — Recognise It With BE-FAST
A stroke is a brain attack. Clot-busting treatment works only within a narrow window, so the time symptoms began is the most important fact you can carry to hospital.
When to call an ambulance immediately
- B — Balance: sudden loss of balance, co-ordination or unexplained dizziness
- E — Eyes: sudden loss or blurring of vision in one or both eyes, or double vision
- F — Face: one side of the face droops when they try to smile
- A — Arms: one arm drifts down when both are raised, or is suddenly weak or numb
- S — Speech: slurred, jumbled, or an inability to speak or understand speech
- T — Time: any one of these appearing suddenly means call 108 immediately
- Also urgent: a sudden worst-ever headache, sudden confusion, or a seizure followed by weakness
What to do
Work through these in order. If you are alone, put your phone on speaker so the 108 call handler can guide you while your hands stay free.
- 1
Note the time and write it down
Record the last moment the person was seen completely normal, not simply when you noticed the problem. If they woke with symptoms, the time they went to sleep is what counts. Thrombolysis and clot-retrieval decisions hang on this single number.
- 2
Call 108 straight away
Ask for the nearest hospital with a stroke unit and round-the-clock CT scanning. An ambulance can pre-alert the stroke team so the scanner is ready when you arrive.
- 3
Lie them down with the head slightly raised
Roughly thirty degrees, supported on a pillow. If they are drowsy or vomiting, place them on their side in the recovery position so the airway stays clear.
- 4
Give nothing by mouth
Stroke frequently impairs swallowing. Food, water or tablets can pass into the lungs and cause a pneumonia that is far harder to treat than the stroke itself.
- 5
Loosen tight clothing and stay with them
Keep the room quiet. Keep reassuring them even if they cannot answer, because comprehension is often intact when speech is not.
- 6
Watch the breathing
If they stop breathing normally at any point, begin CPR and send for a defibrillator.
Never do these
Most of these are well-intentioned and widely believed. All of them make the situation worse.
- Never give aspirin. Unlike a heart attack, a stroke may be a bleed, and aspirin would make it catastrophically worse. Only a CT scan can tell the difference.
- Never give food, water or oral medicines.
- Never wait to see whether the weakness wears off. Symptoms that resolve may be a TIA, a warning of a major stroke within days, and still need same-day assessment.
- Never let them sleep it off.
- Never massage the limbs, apply oils, or try to make them walk.
Once the immediate danger has passed
- Take their medication list, especially blood thinners such as warfarin, acenocoumarol, apixaban or clopidogrel.
- Tell the emergency team immediately if the person takes any blood thinner. It changes management.
- Bring a family member who can describe exactly when symptoms began.
Frequently asked
How long is the treatment window?
Clot-dissolving therapy is generally given within four and a half hours of symptom onset, and mechanical clot retrieval can sometimes be offered up to twenty-four hours in selected patients. Earlier is always better.
The symptoms lasted ten minutes and disappeared. Is that still serious?
Very. That is likely a transient ischaemic attack, and the risk of a full stroke is highest in the first forty-eight hours. It warrants urgent assessment, not a routine appointment.
Why BE-FAST rather than FAST?
The older FAST acronym misses strokes affecting the back of the brain, which typically present with sudden balance and vision problems rather than facial droop. Adding B and E catches those.
Reviewed and written by
Dr. Poonam Sekhon Chahal, MBBS, MEM
Senior Emergency Physician, Manipal Hospital, Patiala · Certified in ACLS, ATLS, PALS and PoCUS