Changes to how we handle STROKE

Changes to how we handle STROKE

A message primarily to: Core Ops Members

Changes to how we handle STROKE

New screening tool, new receiving facility


For a couple of decades or so, our preferred stroke screening exam was the Cincinnati Prehospital Stroke Scale.  It was composed of the following elements:

  • F:  Facial droop, numbness, or unequal movement
  • A:  Arm paralysis, numbness, or unequal strength
  • S:  Speech slurring, loss, or inability to find the right words
  • T:  Time of symptom onset and time “last known well”

The Cincinnati exam was not designed to catch strokes that only affect the posterior circulation of the brain, because at the time, those strokes were considered poor candidates for the clot-busting drug of the day (tPA).  Times have changed, and neurologists have more options now.  Nowadays it’s beneficial for us to use an exam that catches all kinds of stroke.

Strokes affecting the posterior circulation of the brain tend to cause problems with balance and coordination or vision.  So we need to add two new elements to our stroke exam:

  • B:  Balance (trouble walking, dizziness, loss of coordination)
  • E:  Eyes (trouble seeing, blurred vision, loss of vision)

If we put these two elements at the beginning of our exam, we have BEFAST, and that’s the name of our new screening tool.  Old-timers can just think of it as B.E. + Cincinnati:


Additionally, Sentara Independence Hospital is now a certified Stroke Receiving Center.  This means no matter where you are in our city, you can start heading to the closest hospital with your stroke patient.  Make sure you notify them early!


Finally, please remember our quality goals for stroke cases:  Perform the BEFAST exam in the first 5 minutes; the ambulance should spend no more than 15 minutes on scene; determine the Last Known Well (LKW) time and the time of symptom onset; and get a full set of vital signs including blood glucose level.


Thanks to improvements in public awareness, EMS practices, pharmacology, interventional neurology, and other branches of medicine, strokes are often far less devastating than they once were.  Know our system’s goals, and be ready to use the latest examination tools and transport options!

My photo
Division Chief Kevin Lipscomb, NRP
Regulation & Support Services
Va Beach EMS Department