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David J Rowlands AM

Chair, Petitions Committee

National Assembly for Wales

Cardiff Bay


CF99 1NA


16 November 2017





Dear Mr Rowlands


Petition P-05-763 Introduce updated stroke advice - B.E.F.A.S.T. - and help save lives and livelihoods


Thank you for your letter dated 7 August 2017 regarding the petition submitted by Philip Easton and for your invitation to provide our views.


The Stroke Association has been an active proponent of the ‘FAST’ test for a number of years. The FAST test is:



The BEFAST test contains all of these elements, and as described in the petition, problems with eyes and balance.


Stroke is a medical emergency, but one which can vary significantly between different people experiencing a stroke. It can present in a number of different ways and this certainly can include problems with vision and balance. However, while we accept these can be symptoms of a stroke we do not agree with the petitioner that FAST should be replaced by BEFAST for a number of reasons.


The FAST test is one which is evidence based and has been shown to be effective in increasing awareness among the public of the fact that stroke is a medical emergency requiring a 999 response. Our own research in Wales suggests 55% of people can correctly identify both what FAST stands for, and that they should call 999[1]. Changing the message risks reducing awareness of the symptoms and correct response to a stroke. A study of the whole of the UK noted “Delays to seeking and receiving medical attention after major stroke in the UK fell strikingly in 2009, coinciding with the start of the FAST TV campaign”[2].


FAST has also been proven to be an effective test for identifying potential strokes. A 2003 study looked at the use of the FAST test by primary care doctors and in the emergency room. The study looked at 487 patients and found “paramedics using the Face Arm Speech Test achieved high levels of detection and diagnostic accuracy of stroke”[3]. Using a test with a high degree of accuracy is vital due to the large number of non-stroke referrals to stroke services (commonly referred to as stroke mimics). Research suggests anywhere between 5% and 33%[4] of suspect stroke patients may be mimics, with a study of London HASUs suggesting a figure of a quarter of all stroke admissions[5]. Reducing the number of mimics will lower the pressure on existing stroke services.


There is limited evidence to suggest BEFAST would be a more effective test for stroke. One recent study did note 14% of ischemic strokes did not present with FAST symptoms[6] but the evidence remains too limited to suggest it being appropriate to change FAST to BEFAST at present. It is important to note this study also confirms that 86% of ischemic strokes do present with FAST symptoms. The high number of strokes presenting with FAST symptoms makes this an effective test for identifying potential strokes.


The FAST message is one which has been established with a high level of public awareness. Changing this message to BEFAST risks causing confusion among members of the public about what to do if they see these symptoms. This could reduce or delay the number of people seeking medical attention during a medical emergency.


The vast majority of strokes present with FAST test symptoms, which makes this an effective way of identifying potential strokes. In our own promotional materials, while we may concentrate on the FAST symptoms, we do provide information on the other potential symptoms of stroke, including vision and balance problems.


We would like to express our thanks to the petitioner for raising awareness of the symptoms of stroke and our thanks to the Committee for giving us the opportunity to give our views on the petition. The Stroke Association will continue to review evidence around how we can best communicate the risk factors, symptoms and effects of stroke.


Yours sincerely


Matt O’Grady

Stroke Association

Policy, Information and Campaigns Officer, Wales

[1] Research conducted for the Stroke Association by Beaufort Research. Fieldwork conducted in November 2016 and March 2017.

[2] Wolters et al, International Journal of Stroke, Sustained impact of UK FAST-test public education on response to stroke: a population-based time-series study, 8 April 2015, Retrieved 2 November 2017

[3] Harbison et al, Stroke, Diagnostic Accuracy of Stroke Referrals From Primary Care, Emergency Room Physicians, and Ambulance Staff Using the Face Arm Speech Test, 1 January 2003, Retrieved 2 November 2017

[4] Edwards, MJ et al, British Medical Journal, Stroke Mimics in the pre-hospital setting, 18 July 2017

[5] Ibid.

[6] Aroor et al, Stroke, BE-FAST (Balance, Eyes, Face, Arm, Speech, Time) Reducing the Proportion of Strokes Missed Using the FAST Mnemonic, 12 January 2017, Retrieved 2 November 2017