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Impact of bilingual face, arm, speech, time (FAST) public awareness campaigns on emergency medical services (EMS) activation in a large Canadian metropolitan area

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Abstract

Background and aims

Face, arm, speech, time (FAST) public awareness campaigns improve stroke recognition in the general population. Whether this translates into improved emergency medical services (EMS) activation remains unclear. We assessed the association of five consecutive FAST campaigns with EMS calls for suspected strokes in a large urban area of Quebec, Canada.

Methods

We conducted an observational study to assess data collected between June 2015 and December 2019 by the public EMS agency covering the cities of Laval and Montreal (Quebec, Canada). Five FAST campaigns were held over this period (mean duration: 9 weeks). We compared daily EMS calls before and after all FAST campaigns (2015 vs 2019) with t tests and Mann–Whitney U tests. We used single-group, univariate interrupted time series to measure changes in daily EMS calls for suspected strokes following each FAST campaign (stroke categories: any, symptom onset < 5 h, Cincinnati Prehospital Stroke Scale [CPSS] 3/3). Calls for headache served as negative control.

Results

After five FAST campaigns, mean daily EMS calls increased by 28% (p < 0.001) for any suspected stroke and by 61% (p < 0.001) for stroke with symptom onset < 5 h, compared to 10.1% for headache (p = 0.012). Significant increases in daily EMS calls were observed after three campaigns (highest OR = 1.26; 95% CI 1.11, 1.43; p < 0.001). There were no significant changes in calls after individual campaigns for suspected stroke with symptom onset < 5 h, or suspected stroke with CPSS 3/3.

Conclusions

We observed an inconsistent impact of individual FAST campaigns on EMS calls for any suspected stroke, and did not observe significant EMS call changes after individual campaigns for acute (< 5 h) and severe (CPSS 3/3) strokes. These results may help stakeholders identify potential benefits and limitations of public awareness campaigns using the FAST acronym.

Résumé

Contexte et objectifs

Les campagnes de sensibilisation du public Face, Arm, Speech, Time (FAST) améliorent la reconnaissance des AVC dans la population générale. Si cette amélioration de la reconnaissance des AVC se traduit par une amélioration de l'activation des services médicaux d'urgence (SMU) est encore inconnu. Nous avons évalué l'association de cinq campagnes FAST consécutives avec des appels SMU pour suspicion d'AVC dans une grande zone urbaine du Québec, au Canada.

Méthodes

Nous avons mené une étude observationnelle pour évaluer les données recueillies entre juin 2015 et décembre 2019 par l'agence publique EMS couvrant les villes de Laval et de Montréal (Québec, Canada). Cinq campagnes FAST ont été organisées sur cette période (durée moyenne : 9 semaines). Nous avons comparé les appels SMU quotidiens avant et après toutes les campagnes FAST (2015 vs 2019) avec les tests t et les tests U de Mann-Whitney. Nous avons utilisé des séries temporelles interrompues univariées à groupe unique pour mesurer les changements dans les appels quotidiens aux SMU pour des suspicions d'AVC après chaque campagne FAST (catégories d'AVC : tout, début des symptômes < 5 heures, Cincinnati Prehospital Stroke Scale [CPSS] 3/3). Les appels pour maux de tête ont servi de contrôle négatif.

Résultats

Après cinq campagnes FAST, le nombre moyen d'appels quotidiens aux SMU a augmenté de 28 % (p < 0,001) pour toute suspicion d'AVC et de 61 % (p < 0,001) pour les AVC avec une apparition des symptômes < 5 heures, contre 10,1 % pour les céphalées (p = 0,012). Des augmentations significatives des appels quotidiens aux SMU ont été observées après trois campagnes (OR le plus élevé = 1,26 ; IC à 95 % : 1,11, 1,43 ; p < 0,001). Il n'y a pas eu de changements significatifs dans les appels après les campagnes individuelles pour les suspicions d'AVC avec une apparition des symptômes < 5 heures, ou les suspicions d'AVC avec CPSS 3/3.

Conclusions

Nous avons observé un impact irrégulier des campagnes FAST individuelles sur les appels aux SMU pour toute suspicion d'AVC, et nous n'avons pas observé de changements significatifs dans les appels aux SMU après les campagnes individuelles pour les AVC aigus (< 5 h) et sévères (CPSS 3/3). Ces résultats peuvent aider les parties prenantes à identifier les avantages et les limites potentielles des campagnes de sensibilisation du public utilisant l'acronyme FAST.

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Data availability

The data supporting this study's findings are available from the corresponding author, [VB], upon reasonable request.

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Funding

BR received personal funding for this study from Fonds de Recherche du Québec - Santé.

Author information

Authors and Affiliations

  1. Department of Medicine (Neurology), Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Vincent Brissette

  2. Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada

    Bastien Rioux & Alexandre Y. Poppe

  3. Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada

    Bastien Rioux & Alexandre Y. Poppe

  4. Corporation Urgences-Santé, Montreal, QC, Canada

    Thérésa Choisi

Authors
  1. Vincent Brissette
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  2. Bastien Rioux
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  4. Alexandre Y. Poppe
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Corresponding author

Correspondence to Vincent Brissette.

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Conflict of interest

VB, BR and TC report no potential conflicts of interest. AYP has received research grants unrelated to this study from Stryker and unrelated honoraria from Roche Canada (speaker and advisory board). He has also been a spokesperson for the Heart and Stroke Foundation of Canada FAST-VITE campaigns in Quebec and Canada.

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Brissette, V., Rioux, B., Choisi, T. et al. Impact of bilingual face, arm, speech, time (FAST) public awareness campaigns on emergency medical services (EMS) activation in a large Canadian metropolitan area. Can J Emerg Med 25, 403–410 (2023). https://doi.org/10.1007/s43678-023-00482-6

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  • DOI: https://doi.org/10.1007/s43678-023-00482-6

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