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Interactive EMS Scenario

Suspected Stroke: FAST-ED

Assess the patient, calculate the FAST-ED score, and determine the appropriate prehospital priorities.

Training use only: Follow the current Massachusetts OEMS protocols, regional point-of-entry plan, medical control, and local service policy.

Dispatch and Scene

Your ALS ambulance is dispatched for a 68-year-old male experiencing sudden weakness and difficulty speaking.

The patient is sitting in a kitchen chair. He is awake but appears confused and frustrated.

“We were eating breakfast when he suddenly dropped his coffee cup. When I asked what was wrong, he couldn’t answer me.”
Last Known Well8:10 AM
Current Time8:42 AM
Symptom Duration32 minutes

Initial Assessment

AirwayPatent
BreathingRegular and unlabored
CirculationWarm, dry skin
Blood Pressure186/102 mmHg
Heart Rate88, irregular
Respiratory Rate16/min
SpO₂96% on room air
Blood Glucose124 mg/dL
GCS13

Medical history includes hypertension and atrial fibrillation. There is no reported trauma, seizure activity, recent surgery, or known anticoagulant use.

Clinical Assessment

Calculate the FAST-ED Score

Current Score0out of 9
FFacial Palsy

The patient has noticeable drooping of the right side of his face when asked to smile.

AArm Weakness

The patient’s right arm immediately falls and cannot be lifted against gravity.

SSpeech Changes

The patient produces only a few incomprehensible words and cannot identify common objects.

T

Time

Last known well was 8:10 AM. Time does not add points to FAST-ED, but it must be accurately documented.

EEye Deviation

The patient’s eyes are persistently deviated toward the left, and he cannot voluntarily look toward the right.

DDenial or Neglect

The patient recognizes both sides of his body and reacts appropriately when both arms are touched.

Prehospital Priorities

1

Maintain airway, breathing, and circulation.

2

Check blood glucose and consider possible stroke mimics.

3

Establish and document the exact last-known-well time.

4

Perform and document the FAST-ED assessment.

5

Minimize scene time and begin transport promptly.

6

Keep the patient NPO and protect affected extremities.

7

Obtain IV access, cardiac monitoring, and a 12-lead ECG when these do not delay transport.

8

Initiate a stroke alert and provide early receiving-facility notification.

9

Follow current Massachusetts OEMS and regional destination guidance.

Do not attempt to rapidly lower the patient’s blood pressure unless directed by an applicable protocol or medical control.

Hospital Notification

“Stroke alert. We are transporting a 68-year-old male with sudden right facial droop, right arm paralysis, severe aphasia, and forced left gaze. Last known well was 8:10 AM. FAST-ED score is 7. Blood glucose is 124. Blood pressure is 186/102. The patient has a history of atrial fibrillation. Estimated time of arrival is 12 minutes.”