Act FAST – Ryan G., PT

Education is a cornerstone in the therapy world.  As therapists, our job is to educate our patients through varying forms and methods.  Whether it is through an exercise regimen or through preventative measures, some form of education takes place in every patient contact.  One piece of knowledge that I believe to be invaluable to any patient is the acronym to “Act FAST.”

FAST stands for: Face (facial droop), Arm (arm numbness or weakness), Speech (slurred or difficulty speaking and understanding speech), and Time (call 911 immediately).  The first three point to the hallmark signs and symptoms of an oncoming stroke, while the last refers to the extreme necessity to get to a Stroke Center immediately.  Notice, I did not say emergency room, I said Stroke Center. That is because many patients do not realize that it is their right to request a hospital to be taken to by the ambulance, and, unless medical necessity deems it otherwise, the ambulance must comply.  A generic ER can treat a stroke, but not to the efficacy or to the benefit that an ER at a stroke center can.  The local emergency services know which hospitals are stroke centers so they can take easily oblige the patient’s urgent request.  Now, the reason why it is so important for the patient to go to a stroke center is because of what that stroke center can offer more quickly than a generic ER. The stroke center will be certified by JCAHO, and this means it offers fast CT scans to diagnose the stroke, guidelines for fast reaction and communication between the neurologist and on call ER MD, and access to the “miracle” drug t-PA.

T-PA stands for tissue plasminogen activator, which is a fancy word for a clot buster or dissolver.  There are two types of stroke: hemorrhagic and ischemic.  The most common type is ischemic and this is the type that can be treated with t-PA.  If the t-PA is administered in time, then the blood clot that is causing the stroke can be dissolved and, in some case, result in a near total recovery of the patient.  In fact, via testimonial from my wife, she recently evaluated a patient after having a stroke. She went into his home to do the evaluation, found him up talking walking, driving, and doing so well she had to re-check her records to be sure this was the right person and then discharge him because he was not homebound.  This, of course, is a best-case scenario, the drug can cause excessive bleeding that can result in death, but the percentages are low, and the benefits great.  Another caveat of t-PA is that per FDA guidance, the patient must be diagnosed and given t-PA within 3 hours of having the stroke.  This time frame makes the Time in FAST that much important.  Patients must know that they need to respond to the Face, Arm, Speech, and get to the stroke center in Time. 

One more education piece in regard to Act FAST needs mentioning.  Many ER doctors refuse to treat a patient having a stroke and hand them off to another doctor or refuse to administer t-PA for fear of the bleeding risks.  Many of the older doctors shy away from t-PA’s capabilities and hold sway over the younger doctors’ decision in the ER or neurology department. This is slowly changing as stroke centers become more prevalent and younger doctors rise through the ranks and see the research to make their own informed decisions.  We as therapists can further help spread the word by informing our patients of the risk and the benefits of t-PA so that if that day ever comes, the patient and his/her family can be prepared to ask the doctor if they want t-PA.  As therapists it is our duty to educate our patients as much as possible; share the risks, share the benefits, but also share the knowledge of how debilitating a stroke can be so that regardless of what happens in the future the patient will know to Act FAST.

Below are listed Stroke Risk Factors that, if your patient has, they would benefit from being educated to Act FAST.

• High Blood Pressure
• High Cholesterol
• Heart Disease
• Diabetes
• Smoking
• Heavy Alcohol Use
• Physical Inactivity and Obesity
• Atrial Fibrillation (irregular heartbeat)
• Family History of Stroke

Reference:

1.      American Stroke Association. http://www.strokeassociation.org/STROKEORG/