What is it about?

Posterior circulation Stroke (PCS) represents up to 25% of ischaemic strokes and affects more than 20,000 people annually within the UK. Pre-hospital clinical practice guidelines recommend the use of a validated stroke screening tool, such as the ‘Face, Arms, Speech, Time’ [FAST] tool for the assessment of all patients presenting with stroke symptoms. However, with PCS, patients may present with vestibular symptoms, which cannot be detected with ‘FAST’. Furthermore, over one-third of patients with PCS are delayed or misdiagnosed due to a lack of ‘typical’ acute stroke symptoms displayed. The ‘FAST’ tool is deemed to have high sensitivity and moderate specificity in the recognition of Ischaemic stroke. Yet there is evidence within the literature determining that the ‘FAST’ tool is not adequate for pre-hospital screening of PCS, leading to misdiagnosis, treatment delay, and severe life-limiting deficits or death. The aim of this literature search is to evaluate how the use of additional neurological assessment, alongside the validated ‘FAST’ tool, could be used within the pre-hospital setting for the improved paramedic detection of PCS.

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Why is it important?

The evidence examined within this review demonstrates a gap in practice, whereby a combination of a lack of education coupled with poor understanding of PCS is affecting pre-hospital PCS detection. Further assessments of balance and eyes, alongside the validated ‘FAST’ stroke screening tool, could improve paramedic detection of PCS and the inclusion of gait assessment, visual acuity and pupillary constriction would sit within the current paramedic scope of practice. Further research is needed into this topic with regards to the education requirements for paramedics, and the formulation and implementation of a new pre-hospital stroke screening tool for improved PCS detection.


This topic has high personal synergy due to a relative being incorrectly diagnosed due to a lack of awareness regarding PCS. If the paramedic crew had an improved stroke screening tool and enhanced education surrounding the atypical presentation of PCS better patient assessment and management would have taken place.

Mrs nicola Danielle godley
University of Cumbria

Read the Original

This page is a summary of: Neurological assessment with FAST to better detect posterior circulation stroke, Journal of Paramedic Practice, July 2023, Mark Allen Group,
DOI: 10.12968/jpar.2023.15.7.272.
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