Assessment
Stroke Recognition and EMS Action
FAST screening, time-sensitive transport, and prehospital actions that preserve eligibility for hospital stroke interventions.
FAST and expanded prehospital screening
Stroke is a leading cause of serious long-term disability; the CDC urges immediate EMS activation when symptoms appear because treatment windows are narrow.1 FAST evaluates Face droop, Arm weakness, Speech difficulty, and Time to call EMS. Many systems add balance and vision checks (BE-FAST) for posterior circulation strokes missed by arm drift alone.
Last known well time—not symptom discovery time—anchors hospital thrombolysis and thrombectomy decisions. Ask bystanders when the patient was last normal; vague “woke up with it” histories may disqualify intervention. Document glucose early: hypoglycemia mimics stroke and is reversible without stroke center diversion.
Transport and on-scene priorities
MedlinePlus lists sudden numbness, confusion, trouble walking, and severe headache as stroke warning signs requiring emergency care.2 Prehospital priorities: airway and breathing support, position of comfort, oxygen if hypoxic, IV per local scope, and direct transport to the highest appropriate stroke center—not a lower-acuity facility for “stabilization” unless protocol mandates.
Avoid delaying transport for detailed secondary exams when FAST is positive. Notify receiving facilities with ETA and findings; blood pressure management in the field follows protocol—aggressive lowering is not routinely indicated prehospital. Seizure activity may require benzodiazepines per scope before transport continues.
Practice this skill
Apply what you read with a hands-on Stroke Scale drill — instant feedback on every scenario.
