BE FAST: you only need one stroke warning sign to call 911

Many people know the stroke acronym BE FAST. It’s a simple way to remember the biggest warning signs of a stroke: balance, eyes, face, arms, speech, and time.

But there’s one part people sometimes miss: BE FAST is not a checklist you have to complete. You don’t need every sign for it to be an emergency. One sudden change is enough to call 911.

“I’ve had some patients tell me that they didn’t seek care quickly because they did not have weakness or I didn’t notice any facial droop,” says Dr. Taylor Drake, a physical medicine and rehabilitation physician based in St. George, Utah. “When in reality, you really just need one.”

That one point can make a life-changing difference. Stroke symptoms often come on suddenly, and treatment works best when it starts fast.

What causes a stroke?

A stroke happens when part of the brain is injured because it does not get the blood flow or oxygen it needs. There are two main types of stroke:

1. Ischemic stroke (loss of blood flow to part of the brain).
   “This is the most common type of stroke, which happens when blood flow to the brain gets blocked, often by a clot or plaque from cholesterol," says Dr. Bryndon Hatch, the medical director for St. George Regional Hospital's inpatient rehabilitation unit.
2. Hemorrhagic stroke (bleeding within the brain).
   “The other type is called a hemorrhagic stroke, where you have spontaneous bleeding in the brain,” Dr. Hatch says. These strokes are less common, but they can be more life threatening because bleeding can cause swelling and pressure in the brain.

Both types need emergency care. And both can affect how a person moves, speaks, sees, thinks, or feels.

Learn the BE FAST signs of stroke

The BE FAST acronym helps you spot possible stroke signs quickly. Each letter stands for a warning sign to watch for.

• BALANCE: Sudden trouble walking, dizziness, loss of coordination, or falling to one side.
• EYES: Sudden vision changes, double vision, or loss of vision in one eye or part of your vision.
• FACE: One side of the face droops, looks uneven, or does not move normally when the person smiles or talks.
• ARMS: Sudden weakness, numbness, poor grip, or loss of control in one arm or one side of the body.
• SPEECH: Slurred speech, trouble finding words, words that do not make sense, or trouble understanding what others are saying.
• TIME: Call 911 right away.

One of the most important things to remember is this: you do not need every BE FAST sign to call 911. In fact, most of the time, a person will not have every stroke symptom at once. That does not mean it is safe to wait.

“Any one of those signs in the BE FAST can warrant going to the emergency room,” Dr. Drake says.

So if someone you love says they are fine but suddenly cannot speak clearly, walk normally, smile evenly, or see well, speak up. Calling 911 is not overreacting. It is the right step.

The faster a person gets to the hospital, the faster the stroke team can decide what treatment may help.

Can someone be having a stroke and not know it?

Sometimes symptoms are obvious, like a face that droops or an arm that cannot move. Other times, the signs are easier to explain away. Here are some of the less obvious signs of stroke:

• Suddenly drop objects because their grip feels weak
• Sound tired, confused, or “off”
• Fall over while walking
• Have sudden vertigo, which means the room feels like it is spinning
• Lose part of their vision 

Dr. Hatch says many patients try to wait it out if they notice some of the more subtle signs, which is a mistake.

“Don’t minimize your symptoms or try to ‘sleep it off.’ Get evaluated,” he says.

Should you call 911 or drive to the ER for stroke symptoms?

If you think you or someone else is having a stroke, call 911. Even if the hospital is close, emergency medical services can start the stroke response before the patient arrives.

“If EMS knows that there’s a potential stroke, they can activate what’s called a ‘code stroke’ while they’re en route and have neurology at the hospital ready,” Dr. Hatch says. “It gets the ball rolling for treatment to happen a lot faster once the person gets to the hospital.”

He also warns: Driving yourself is not safe. Stroke symptoms like arm weakness or vision changes can start small and get worse quickly.

Reduce the stroke risks you can control

Some stroke risks cannot be changed. Age is one of them. “Age is the most important risk factor, and it gets worse as they get older,” Dr. Drake says. Genetics can also play a role.

Dr. Hatch points to diabetes, high blood pressure, high cholesterol, atrial fibrillation (A-Fib), sleep apnea, smoking, low physical activity, and diet as areas where prevention can make a difference.

Many stroke risk factors can be identified early and managed with your provider.

“You could have high blood pressure and just never know it,” Dr. Drake says. Many people feel healthy, so they skip checkups. But blood pressure can stay high for years without clear symptoms. Over time, that can strain blood vessels and raise stroke risk.

You can take our stroke risk assessment to see if you’re at a higher risk for a stroke.

BE FAST saves lives

If you see one sudden BE FAST warning sign, don’t wait. Call 911. Fast action can protect the brain, support recovery, and help you or someone you love get the right care as quickly as possible.

At Intermountain Health, our emergency teams, stroke specialists, rehabilitation experts, and primary care providers work together to help people prevent stroke, recognize it quickly, and recover with support.

With 31 stroke centers, 188 neurologists, 100 spine and neurosurgeons, and five exceptional inpatient rehabilitation units, Intermountain Health is here to help you get expert care when every minute matters.

For more information on our nationally-recognized brain, spine, and nerve care, click here.