A stroke occurs when blood flow to a part of the brain is blocked, or when a blood vessel in the brain bursts. Every minute counts when someone is having a stroke, because brain cells start dying within minutes of disrupted blood flow. Recognising early warning signs can be the difference between life and serious disability.
The FAST rule
The acronym FAST, with regard to strokes, stands for:
F – Face Drooping: One side of the person’s face might sag or feel numb. Ask them to smile — if one side doesn’t move as well the other side, this is a red flag.
A – Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. If one arm drifts down or can’t be lifted, this is a warning sign.
S – Speech Difficulty: Slurred speech, trouble talking, or difficulty understanding what’s being said are all signs. Even if the speech differences are subtle, take notice.
T – Time to call emergency services: If you observe any of the above, call for help immediately and note the time the symptoms started. Time is brain!
These checks are simple, quick and can be done by anyone — at work, at home, or anywhere else. When it comes to strokes, early recognition is key.
Why the urgency
In India, the stroke burden is heavy, and is rising. Research shows that the incidence rate (new cases per year) ranges from about 105 to 152 per 100,000 persons. The prevalence (total existing cases) is also climbing, and stroke is now one of India’s leading causes of death and disability.
Given these numbers, recognising a stroke early is essential. Some strokes are amenable to treatments — for instance, clot-busting drugs and procedures become much more effective if used early. That is why the FAST rule emphasises “Time”.
Inside the body
When a stroke occurs, either a blood vessel in the brain becomes blocked (ischemic stroke) or a blood vessel bursts (haemorrhagic stroke). Lack of oxygen and nutrients causes brain cells to begin dying. According to one medical review, as soon as the symptoms start, the damage begins. The FAST signs show you when that damage has begun making visible changes: a drooping face means one side of the brain is affected; arm weakness shows impaired muscle control; speech trouble indicates language centres are impacted. The earlier someone gets help, the lower the chances of irreversible damage being done.
Data on the FAST rule
The FAST rule is widely adopted, and is promoted by the American Stroke Association and other stroke awareness groups as well. However, diagnostic accuracy varies, depending on the severity of the condition. A recent analysis found that in mild strokes, only about 23-32 % were FAST positive, whereas in moderate and severe strokes, over 94 % were FAST positive.
What this means is that FAST is great for raising the alarm quickly, but not every stroke will show all three signs. If you see any sudden change in the face, arm or speech therefore — don’t wait, call for medical help immediately.
Knowing what to do
The first thing to do if you notice signs of a stroke is to call your local emergency number ( 108 or 112 in India) right away and clearly say, “I suspect a stroke.” Make sure to note the exact time the symptoms began, as this helps doctors decide on treatment options. While waiting for help, stay calm and reassure the person. Keep them lying down in a safe, comfortable position, with their head slightly elevated, and avoid giving them food or water until a medical professional evaluates them.
Once at the hospital, inform the healthcare team about when the symptoms started — this timing can determine whether the person qualifies for clot-busting treatments such as thrombolysis. For everyone’s awareness, it’s important to learn the FAST rule — and for extra caution, the extended “BE-FAST,” which adds balance and eye changes — and share it with friends and family. Knowing these simple steps can make the difference between recovery and lasting disability.
Stroke can strike anyone, any time — and fast action can save lives and reduce disability. Stay informed and stay alert — you could save a life.
(Dr. Swaroop Gopal is group director, Aster International Institute of Neurosciences and Spine Care, Aster Whitefield Hospital, Bengaluru. swaroopdr@gmail.com)
Published – October 29, 2025 06:56 pm IST
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