BEFAST is the most important acronym in stroke care. Recognizing stroke symptoms immediately and calling 911 without delay is the single most powerful thing you can do to improve a stroke survivor's outcome. This lesson makes BEFAST automatic.

Section 01

Why BEFAST Replaced FAST

The original FAST acronym added Balance and Eyes to capture earlier warning signs, particularly in posterior circulation strokes.

🚨 BEFAST — Know Every Letter
B — Balance: Sudden loss of balance or coordination. Stumbling, dizziness, difficulty walking without explanation.

E — Eyes: Sudden vision changes — blurred, double, or loss of vision in one field. Sudden and new, not chronic.

F — Face drooping: Ask them to smile. Is one side drooping or numb? An uneven smile is a warning sign.

A — Arm weakness: Ask them to raise both arms. Does one drift downward? Weakness or numbness in one arm.

S — Speech difficulty: Ask them to repeat a simple sentence. Is speech slurred, strange, or absent?

T — Time to call 911: If ANY of these signs are present — call 911 immediately. Note the exact time symptoms started.
Section 02

Why Onset Time Matters

⚠ Note the time — it is clinical information
The exact time symptoms began determines whether the survivor is eligible for tPA (within 3–4.5 hours) or mechanical thrombectomy. Always tell 911 the time symptoms started. If unknown — for example, a wake-up stroke — say that too. Wake-up stroke has specific protocols.
Section 03

Recognizing a Second Stroke in a Survivor

  • New or worsening symptoms: Any deficit that was improving that suddenly worsens, or new symptoms — treat as potential new stroke.
  • Sudden severe headache: Particularly in hemorrhagic stroke survivors — red flag requiring 911.
  • Any new neurological symptom: New facial droop, arm weakness, speech difficulty — even if similar deficits existed from the first stroke, new changes mean 911 immediately.
Section 04

What NOT to Do When You Suspect Stroke

🚨 Never do these when stroke is suspected
  • Do not drive them to the hospital — call 911. Paramedics alert the hospital en route.
  • Do not give food or water — stroke impairs swallowing, aspiration risk.
  • Do not give medication unless directed by the 911 dispatcher.
  • Do not wait to see if symptoms improve — TIA symptoms resolve but TIA is still a 911 emergency.
  • Do not leave the person alone until EMS arrives.
Section 05

Making BEFAST a Reflex

✓ Practice at the start of every shift
Check mentally at every shift start: Normal balance? Vision changes? Face symmetric? Arms equally strong? Speech as usual? Any change from baseline — you know what to do.
Knowledge Check

Lesson 1 Quiz

5 questions · Passing score: 80%
Question 1
The 'B' in BEFAST stands for:
Question 2
You notice a stroke survivor's left arm appears weaker than yesterday and speech sounds different. You should:
Question 3
Why call 911 rather than drive a suspected stroke patient to the hospital?
Question 4
When calling 911 for a suspected stroke, what critical piece of information must you always provide?
Question 5
A survivor wakes from a nap with new symptoms and you don't know exactly when they started. You should tell the dispatcher: