The Efficacy of FAST and Public Health Interventions in Mitigating the Impact of Stroke

Introduction

Stroke has been quoted as the third leading cause of death on a global basis and major cause of severe disability among the adult population, within the developed countries. In case of acute ischaemic stroke, the act of rapid thrombosis within a span of 4.5 hours can improve the level of prognosis with high rates of benefit from earlier treatment (Sudirman, Yuliyanti and Sari, 2020). In similar regards, an expeditious response to symptoms of stroke is important. Many patients are late to hospital due to a series of reasons that may lead to health degradation. Mass media related interventions are promoted as an effective method of answering health issues and change in behaviour, encouraging the use of the right kind of services. The essay, therefore works on understanding the efficacy of FAST and associated public health programs in reducing impact of stroke. Such interventions targeted at stroke are seen to have a positive impact on the level of knowledge among the people, including awareness and the need for an immediate response with limited impact on public behaviour.

Efficacy of FAST in controlling stroke

The efficacy of FAST in controlling and identifying the signs of stroke. As stated by Rocha and Jovin (2017), public health intervention was termed as a suitable way of influencing the general public for ensuring that the health related objectives are rightly met. A research study conducted by Morrow, Miller, and Dombrowski (2019), analysed the campaign that included printed materials, posters and leaflets available in primary care. The findings coincided with the fact, raising awareness about the possible signs of stroke on the basis of current use of FAST in social marketing events may not be strong enough to reduce the pre-hospital related delays at a high level of population, thus having minimal impact on the public health

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Sudirman, Yuliyanti and Sari, (2020) formed a simple modification of the FAST, making it BE-FAST, where B stands for balance and E for the eyes. The implementation of the mentioned aspect was seen to exhibit high rates of efficacy. Roughly 14% of research participants with acute stroke would be missed through the implementation of FAST alone and the mentioned proportion was reduced to 4.4% with the history of gait and visual symptoms explained through BE-FAST (Utswmed.org, 2020). A similar study conducted by Flynn et al. (2014) stated that the method was highly effective to enhance the knowledge of the patients and associated family members in recognising stroke. Bouslama et al. (2019), the Act FAST intervention delivered by student pharmacists increased knowledge related to signs and symptoms coupled with modifiable risks associated with strokes. This works on suggesting the level of preparedness and knowledge in terms of primary prevention related to stroke. The Act FAST campaign may be termed as a useful tool for training health care professionals. Sudirman, Yuliyanti and Sari (2020), delay in receiving and seeking medical care after a significant stroke in the UK fell during 2009. Additionally Pickham et al. (2019), argued the fact that knowing the symptoms related to stroke can help the patient to ensure quick improvement while improving the overall outlook. Early treatment can increase the rates of survival while decreasing the risk of serious complications witnessed in the stroke such as; paralysis or weakness of muscles in one side of the body, coupled with difficulty in speaking or swallowing. Gong et al. (2019), additionally suggested, memory loss or difficulty in understanding a language and thinking can be a wider manifestation of stroke. Tingling sensation, changes in behaviour is another is additional manifestation of stroke on the human body.

The T in FAST is not an acronym rather it is an important factor that decides the importance of time in treatment of stroke. A research conducted by Carr et al. (2020), states that faster a person who suffers from stroke receives medical attention, greater are the chances of saving the life while reducing the long term effects associated with stroke. In similar regards, there are two types of strokes and time emerges out as a vital aspect for ensuring successful treatment in both the cases. The first type is the ischemic stroke occurring when blood clots block the blood vessel in the brain. Approximately, 85% of heart attacks are ischemic in nature (Carr et al. 2020). A transient ischemic attack occurs when blood flow in a certain part of the brain is reduced or blocked for a short span of time. The blood flow becomes normal once the blockage is removed. Ischemic stroke is often treated with the use of clot busting drugs termed as tissue plasminogen activator. The drug is seen to dissolve the clot and ensure that the blood clot in certain parts of the brain is markedly improved. If the medication is given within the span of three hours of stroke, the patient has better chances of recovery. Unfortunately, stroke victims fail to make it to the hospital in time. Surgical procedures to extract clot is additionally termed as a way for removing clots in certain cases. Herrmann et al. (2019), suggested performing an endovascular procedure within a span of eight hours after the initial arrival of stroke symptoms

The other type of stroke is the hemorrhagic stroke representing 15% of all cases and responsible for 40% of deaths due to stroke (Lowrey et al. 2019). During the course of hemorrhagic stroke, blood spills around the brain or into the brain creating a temporary swelling which creates pressure damaging the cells and tissues in the brain. The hemorrhagic stroke is seen to make use of medication for reducing the bleeding of the blood pressure. However, the administration of medicine is in itself an emergency that must be done on the right time; thus, it can be conclusively stated time is an important factor. Hence, it would be fair enough to conclude that FAST is an important aspect with high rates of efficacy in controlling the chances of stroke. However, research based study, points out the primary drawback of FAST as its inability to not identify as many stroke related symptoms other than the one mentioned (Zhao et al. 2019). Nevertheless, the acronym FAST was discovered to detect and enhance the level of responsiveness to the needs of an individual experiencing stroke. Positive results towards FAST does not always hint towards stroke, patients with FAST positive test may have a stroke mimic diagnosis. Careful attention in regards to the speed of onset of symptoms is of prime importance.

Rocha and Jovin (2017) stated the fact, a holistic approach to care is of prime importance and FAST can work on providing the expected attention to detail for proper care. F stands for face referring to numbness or facial dropping from one side, asking the person to smile can make the drooping apparent. A refers to arms being numb or weaker, It is important for an individual to raise up both the arms for 10 seconds, if one arm begins to fall or drop then it could be a sign of stroke. S refers to stability, as stroke often messes with the stability of the person affected. Sometimes the individual may fall, or fail to stand without help. Thus, difficulty in maintaining coordination is one of the major symptoms of onset of stroke. The acronym T stands for talking which is subjected to change due to onset of stroke. As pointed out by Flynn et al. (2014), individuals are subjected to difficulty speaking during the onset of stroke making speech an important aspect of finding the events related to stroke. The E for eyes is an aspect of visual change. The visual change occurs suddenly and includes complete loss of vision in one eye or another. R is for react for calling the emergency health services after recognising the symptoms. Hence, it can be stated identifying the symptoms at quick instance helps in achieving proper treatment for people experiencing stroke.

The message content related to FAST in England did not concentrate on overcoming the potential barriers in overcoming the expected outcome of calling an ambulance or address the belief linked with the availability of effective emergency medical treatment such as thrombolysis. Impact may be observed with the addition of the mentioned components to the content. The message pertaining to emergency admissions and thrombolysis is related to impact on patients with possible outcomes. The findings are important; however needs to be analysed with some caution. In similar regards Vo et al. (2017), pointed out the efficacy of FAST through educational intervention provided by medical students (pharmacy). The research stated the fact FAST increased the knowledge pertaining to signs and symptoms, coupled with immediate management. The study suggests that pharmacists may have a positive impact on the level of preparedness and knowledge related to primary intervention of stroke. The Act FAST related campaigns can be termed as a careful tool for training the healthcare professionals for ensuring better provision of care among the patients suffering from underlying cardiac issues.

Stroke preparedness and knowledge pertaining to primary prevention was assessed with the implementation of post and pre-intervention based community health fairs. The intervention was a FAST based educational session with screenings of blood glucose and pressure. Hence, Gong et al. (2019), stated the fact the stroke incident was greatly reduced due to the advent of FAST related activities. The proof related to increased level of public awareness to stroke related information can be easily found in web pages and website hits. Nevertheless, adjusted analyses indicate that stroke association and possible outcome may lead to severe health implication. In contrast to the retrospective audit of stroke patients, findings provide an enduring evidence of the campaign on increased awareness of stroke related prevention and care and more people arriving at secondary care due to limited interaction with the general physician as first response related to stroke symptom, with great number of patients arriving at care centres within the onset of stroke.

In contrast to the finding above, a similar FAST campaign was seen in Ireland in 2010 was shown to lack sustained impact on the emergency departments. The reasons for such evident differences between evaluation and findings are complicated and indeed multifactorial in nature making it difficult to explain the active components associated with the dual nature, public and professional to understand the nature and impact of stroke on a chosen population.

The ultimate decision can be made that stroke has been cited as the third driving reason for death on a worldwide premise and significant reason for extreme inability among the grown-up populace, inside the created nations. If there should be an occurrence of intense ischaemic stroke, the demonstration of fast thrombosis inside a range of a couple of hours can improve the degree of forecast with high paces of advantage from prior treatment. In comparative respects, quick reaction to manifestations of stroke is significant (Carr et al. 2020). Numerous patients are late to medical clinics because of a progression of reasons that may prompt wellbeing debasement. Broad communications related mediations are advanced as a compelling technique for noting medical problems and change in conduct, empowering the utilization of the correct sort of administrations. The implication of FAST is made mandatory for the following reasons:

It is simple

It is easy to use

Make use of observational skills, readily available among people irrespective of knowledge

No need of prior professional skills

The symptoms that needs to be observed are highly visible

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Conclusion

The efficacy pertaining to FAST cannot be stressed enough. The probable efficacy of the same can be highlighted through the instances of BE-FAST, a modified version of FAST that can work on adding some extra features to make sure that the stroke related symptoms are rightly addressed. However, it can be additionally concluded that the symptoms of stroke are not limited to the ones mentioned in FAST. The symptoms may be varied and subjective to patients. For complicated cases it is important to contact a general physician, ensuring better health outcomes among the patients. The resistance to ailments are increasing at a rapid space; thus it is important to understand and evaluate proper ways that can work on ensuring the health needs are rightly met providing better health outcomes.

Reference list

Bouslama, M., Haussen, D., Grossberg, J., Barreira, C., J. van der Bom, I.M., van Nijnatten, F., Grünhagen, T., Moyer, L., Frankel, M. and Nogueira, R., 2019. Abstract WMP15: Flat Panel Detector CT Assessment in Stroke to Reduce Times to Intra-Arterial Treatment (FAST-IA): A Study of Multi-Phase CTA in the Angiography Suite to Bypass Conventional Imaging. Stroke, 50(Suppl_1), pp.AWMP15-AWMP15.

Carr, K., Yang, Y., Roach, A., Shivashankar, R., Pasquale, D. and Serulle, Y., 2020. Mechanical Revascularization in the Era of the Field Assessment Stroke Triage for Emergency Destination (FAST-ED): A Retrospective Cohort Assessment in a Community Stroke Practice. Journal of Stroke and Cerebrovascular Diseases, 29(1), p.104472.

Flynn, D., Ford, G.A., Rodgers, H., Price, C., Steen, N. and Thomson, R.G., 2014. A time series evaluation of the FAST National Stroke Awareness Campaign in England. PloS one, 9(8).

Gong, X., Chen, Z., Shi, F., Zhang, M., Xu, C., Zhang, R. and Lou, M., 2019. Conveniently-grasped field assessment stroke triage (CG-FAST): a modified scale to detect large vessel occlusion stroke. Frontiers in neurology, 10.

Herrmann, A.M., Cattaneo, G.F.M., Eiden, S.A., Wieser, M., Kellner, E., Maurer, C., Haberstroh, J., Mülling, C., Niesen, W.D., Urbach, H. and Boltze, J., 2019. Development of a routinely applicable imaging protocol for fast and precise middle cerebral artery occlusion assessment and perfusion deficit measure in an ovine stroke model: a case study. Frontiers in Neurology, 10.

Lowrey, C.R., Bourke, T.C., Bagg, S.D., Dukelow, S.P. and Scott, S.H., 2019. A postural unloading task to assess fast corrective responses in the upper limb following stroke. Journal of neuroengineering and rehabilitation, 16(1), p.16.

Morrow, A., Miller, C.B. and Dombrowski, S.U., 2019. Can people apply ‘FAST’when it really matters? A qualitative study guided by the common sense self-regulation model. BMC public health, 19(1), p.643.

Pickham, D., Valdez, A., Demeestere, J., Lemmens, R., Diaz, L., Hopper, S., de la Cuesta, K., Rackover, F., Miller, K. and Lansberg, M.G., 2019. Prognostic value of BEFAST vs. FAST to identify stroke in a prehospital setting. Prehospital Emergency Care, 23(2), pp.195-200.

Rocha, M. and Jovin, T.G., 2017. Fast versus slow progressors of infarct growth in large vessel occlusion stroke: clinical and research implications. Stroke, 48(9), pp.2621-2627.

Vo, L.P., Souksavong, J.H., Tran, A., Chang, J. and Lor, K.B., 2017. Impact of the Act FAST stroke campaign delivered by student pharmacists on the primary prevention of stroke. Journal of the American Pharmacists Association, 57(3), pp.326-332.

Zhao, H., Smith, K., Bernard, S., Stephenson, M., Parsons, M., Yassi, N., Davis, S.M. and Campbell, B.C., 2019. Abstract TMP64: In-Field Paramedic Validation of the Ambulance Clinical Triage for Acute Stroke Treatment (ACT-FAST) Algorithm for Endovascular Thrombectomy. Stroke, 50(Suppl_1), pp.ATMP64-ATMP64.


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