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Estrada Bernard: 3 Things Every Clinician Should Be Teaching Their Community About Stroke

Estrada Bernard/LinkedIn

Mar 22, 2026, 12:16

Estrada Bernard: 3 Things Every Clinician Should Be Teaching Their Community About Stroke

Estrada Bernard, Neurosurgeon in Henderson, Nevada, shared on LinkedIn:

”Three things every clinician should be teaching their community about stroke — and one data point that should change how we talk about FAST.

Most public stroke education still revolves around the FAST acronym.

It is memorable, widely adopted, and reasonably effective—particularly for anterior circulation strokes.

But the data tells a more nuanced story.

1. FAST misses a meaningful subset of strokes

FAST has a pooled sensitivity of ~77%. Critically, it can miss up to 39% of posterior circulation strokes—those presenting with vertigo, imbalance, or visual disturbances rather than classic hemiparesis.

Expanding to BE-FAST (adding Balance and Eyes) reduces missed strokes from 14.1% to 4.4% in validation studies.

Yet, as of 2024, 35% of U.S. Comprehensive Stroke Centers still rely on FAST alone in public-facing materials.

2. Time is not just brain — it is probability

The relationship between time and outcome is stark:

NNT = 5 at 0–90 minutes
NNT = 9 at 91–180 minutes
NNT = 15 at 181–270 minutes
(Emberson et al., Lancet 2014)

For bridging therapy prior to thrombectomy, benefit declines by ~16% per hour.

The most controllable variable in this chain?

Prehospital delay — driven almost entirely by public recognition.

3. In resource-limited settings, one intervention stands above the rest

The single highest-yield strategy to improve door-to-needle time is EMS pre-notification.

It requires no advanced technology—just coordination.

It transforms stroke care from sequential to parallel processing.

The takeaway:

Public education is not ancillary to stroke care.
It is stroke care.

I am interested in how others are approaching this:

What updates have you made to stroke recognition training in your institution?

Particularly interested in perspectives from colleagues working in Sub-Saharan Africa and Southeast Asia, where system-level adaptations can have outsized impact.

New episode: ‘Suspect a Stroke? A Neurosurgeon Explains Exactly What to Do in the Next 10 Minutes’”

Estrada Bernard: 3 Things Every Clinician Should Be Teaching Their Community About Stroke