Do No Harm
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Do No Harm

That’s Not What Time Means

They taught you the wrong stroke assessment

I became a lifeguard when I was 15 and started teaching Lifeguarding, First Aid, and CPR classes only a few years later. I loved it. I loved teaching and I loved finding a way to help people learn the information not only for the test, but to remember it forever. I also really enjoyed telling these young lifeguards that they were receiving the same training that is required of doctors and nurses. It’s true, lifeguards are required to obtain the same level of Basic Life Support (BLS) certification that hospitals require for professionals.

A lifeguard student pretending to do CPR during one of my classes. Great hand placement!

The way I thought about it, these skills would be used only a few times in an average person’s life — thankfully, life-and-death rescues and CPR aren’t commonplace at pools. Besides the infrequency of use, I imagined these skills would be hard to remember by someone pumped full of adrenaline when they need to jump into action. I knew that unless a person constantly reviewed these skills, they would be lost.

Because of this, I tried to explain the rationale and the science behind what I was teaching. I explained how the heart works and the basics of its electrical conduction system. I tried to make it fun and memorable so that if they ever needed these skills, they’d have the confidence to perform them. (This became the motto of my training company: “Boosting Knowledge Through Confidence”).

When I taught the lesson for recognizing a stroke victim, the mnemonic was simple. FAST: Face, Arm, Speech, and Time. It was such a quick test to identify a potential stroke. I enjoyed its simplicity and that the acronym itself (“FAST”) emphasized the time-sensitive nature of a stroke.

Shockingly, since my time as a lifeguard instructor, I have noticed a change in the way the FAST assessment is taught. It surprised me that even professional organizations and textbooks seem to have misunderstood the intent of FAST. If you Google it, you’ll find that the “T” still stands for “time.” However, you’ll find that it simply refers to “time to call 911” or “time is brain, call 911 now.”

While acting quickly is important, that’s not what “time” was supposed to mean! The “FAS” part of it identifies the symptoms of a stroke. The “T” was intended to remind people to determine the “time of onset,” otherwise known as “last known well time.”

The time of onset is such an important piece of medical information when treating a stroke patient. Certain potentially life-saving procedures are extremely time-sensitive and can only be initiated within a strict timeframe. If the time of onset is unknown, it may disqualify the patient from receiving these treatments. It is imperative that bystanders determine the time a person was known to have started showing symptoms. Therefore, “time” was important on the FAST assessment.

It disappoints me that the medical community has seemingly forgotten this important piece of information. I made an infographic which includes the correct meaning of “time.” You may use it however you wish.

Please spread this information, as it may be helpful to someone.

David I. Mancini is a Registered Nurse and a Licensed Paramedic. He’s a tech enthusiast, world traveler, and an eclectic eater.



Do No Harm is a collection of articles written by members of the medical field. Some are written for others in the profession, while others are intended for the general public. No articles are to be interpreted as medical advice; talk to your own doctor.

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David I. Mancini, RN

David I. Mancini is a Registered Nurse and a Licensed Paramedic. He’s a tech enthusiast, world traveler, and an eclectic eater.