May 9, 2013



Over the past few months the commercial TV channels have shown a powerful commercial depicting a “Fire in the Brain” highlighting what to do if it is suspected that someone is suffering a stroke.

What is a stroke? In simple terms a stroke occurs either when a blood vessel becomes blocked or ruptured preventing blood to continue on its course to provide life giving oxygen to keep the brain alive. The location of the blockage or rupture can determine the seriousness of the event and perhaps how the casualty will be affected. 

Why does it occur? There may be many reasons for a stroke occurring including the effects of prolonged high blood pressure.

With such a serious life affecting condition you might expect that everyone’s first actions would be to call the emergency services. However in a recent report from a study carried out in America it was found that this hadn’t been the case.

The study had analysed the records of nearly 204,000 stroke victims across 1,563 hospitals during the period 2003-2010 and found that no contact was made with the emergency medical services for 36% of stroke victims.

The results showed that 63.7% of stroke victims arrived at hospital after the emergency medical services had been contacted. The remaining victims arrived by various other means having not contacted the emergency services.

While it is perfectly reasonable to expect some stroke victims to get to hospital with the help of family and friends the study found that this approach may have led to a delay in their treatment. Where the emergency services had been contacted 79% of the casualties were transported to a nearby hospital within hours of their initial symptoms which meant earlier evaluation and treatment. This compares with only 40% of those who didn’t use the emergency services.

Further information shows that 55% of those transported to hospital by the emergency services were receiving a brain scan within 25 minutes of arriving at hospital compared with only 35.6% who arrived by other means.

The speed of providing treatment for stroke victims is very important and there are number of surgeons who claim that the effects of a stroke can be almost if not completely reversed if the patient is operated on within three hours.

“Okay, but what’s this got to do with us? That’s America it’s not the UK” I can hear many in the UK shouting at this page. However lessons learned even from across the Atlantic may help reduce the impact of a stroke on someone close to you.

So let’s have a look at some of the common reasons given why the American Emergency Services were not contacted.

One of the main reasons why the emergency services had not been contacted was simply friends, relatives and the patient didn’t recognise the symptoms of a stroke.

Another very popular answer was that they didn’t want to be a burden or to bother anyone. Listening to many elderly relatives and friends over the years I suspect that this answer was typically from an older person.

In America they have many more hospitals than we do in the UK but not all of them have the expertise to deal with stroke victims and the emergency services would know which hospital to take the casualty to which would prevent the non assisted casualty arriving at one hospital only to be referred to another.

Similar to findings in America it is likely that a proportion of stroke victims in the UK go to their GP before being referred to the hospital further delaying their treatment simply because they or family and friends do not recognise the symptoms. Therefore it is so important that everyone should understand what to do if one of their relatives or friends suffers a stroke.

So what are the recognition signs of someone suffering from a stroke?

The St John’s Ambulance First Aid Manual informs us that there MAY be:

  • Problems with speech and swallowing;
  • If asked to show teeth only one side of the mouth move or the movement will be uneven.
  • There may be a loss of power or movement in the limbs.
  • Sudden severe headache
  • Confused emotional mental state that could be mistaken for drunkenness
  • Sudden or gradual loss of consciousness


Other sources also include a general feeling of being unwell and in really severe cases one pupil may not react to light making the pupils look unequal in size.


To aid recognition the F.A.S.T. test is the recognised process to use.


F = Face 

Ask them to smile. Does their face look lopsided or does the mouth or eye look as if it is drooping on one side


A = Arms 

Ask the person to raise both arms above their head. Can they raise them equally?


S = Speech

Can the person speak clearly and understand what you say?


T = Time 

If the person fails any one of these tests it’s TIME to call an ambulance and explain you believe the person may have had a stroke.


Do Not Delay; Do It Straight Away 


Prompt medical care can reduce further damage to the brain and help the casualty recover more completely.

While you wait for the ambulance; stay with the casualty, reassure them. Lay them down but position them so that their head and shoulders are raised as this should help to counter any breathing difficulties. Loosen any restrictive clothing e.g. ties and collars, support any limb that may be paralysed. Please don’t give them anything to eat or drink and no cigarettes to smoke. Also be aware that they can probably hear you when you talk to others so think about the effect your words may have on them.