FAST BEE (Keeping FAST First): A Public Stroke Education Design to Drive EMS Activation

Improving stroke recognition and promoting immediate action are critical to enhancing prehospital stroke care. For two decades, the FAST (Face, Arm, Speech, Time) mnemonic has been widely taught, yet it fails to capture many posterior circulation strokes. To address these limitations, BE FAST (adding Balance and Eye symptoms) was introduced but showed reduced recall for more common symptoms represented by FAST, likely due to common symptoms being placed after less common ones, thus weakening retention of the original FAST elements. To improve both detection and action, we propose FAST BEE-keeping FAST first and adding BE after FAST with an additional "E" for Emergency Medical Services (EMS) call. This structure reinforces the urgency of activating EMS by repeating the call-to-action within the mnemonic. We further introduce a novel FAST BEE cartoon as a visual tool to enhance learning, recall across diverse populations, and immediate action (EMS call) in public. Using the bee metaphor provides a memorable, engaging, and globally adaptable educational strategy in English-speaking populations. FAST BEE offers a fresh, action-oriented framework that builds on the familiarity of FAST, emphasizes immediate EMS activation, and holds promise to strengthen stroke action awareness worldwide. Further evaluation of effectiveness in various English-speaking populations is needed.