Bring Stroke Education to High Schools

According to a recent survey of nearly 25,000 adults aged 30 or younger, nearly 29% of respondents were not aware of the five signs of stroke. More worrisome was that 3% were not aware of any stroke symptoms at all! With strokes on the rise in the United States and blood clots becoming a larger concern as an effect of COVID-19, there is clearly a need to increase public education about strokes. It should start with an addition to high school health curricula across the country.

The survey used data from the 2017 National Health Interview Survey and gauged awareness of the five primary stroke symptoms among young adults. These most common stroke symptoms, according to the American Heart Association, can be remembered by the acronym BEFAST.

Balance—Patients experiencing a stroke or transient ischemic attack (TIA) report feeling dizzy, a headache, and a loss of balance or ringing in the ears.

Eyes—Signs of a stroke or TIA can include unequal pupils and blurred or double vision.

Face—A facial droop, or one side of the face sinking lower, is a frequent sign. This can be assessed by asking a patient to smile or stick out their tongue.

Arms—Patients often have weakness or reduction of motor function in the arms, often on one side of the body. This can be assessed by asking patients to hold up both arms at the same time to determine if one is weaker or has less motor function than the other. The same applies to legs.

Speech—Slurred speech, or aphasia, is a sign of stroke or TIA. This can be assessed by asking patients to repeat a full sentence like, “The quick brown fox jumped over the lazy dog.”

Time—“Time is brain,” and that means if any of these signs or symptoms is present, 9-1-1 should be called immediately for an ambulance and both BLS and ALS. Clot-busting drugs have a time window, so the quicker the patient can get to a hospital, preferably one designated as a stroke center, the better their chance for rapid treatment and recovery.

These are signs, symptoms, screening, and courses of action that should be added to high school-level health curricula. It shouldn’t even be that big of a challenge, as many schools already teach lifesaving skills and information.

CPR, for example, has long been a part of instruction in high school health classes. According to a 2019 survey by the Mayo Clinic as well as the American Heart Association, 38 states now mandate CPR training for graduation, and this affects more than a million students. According to the Mayo Clinic, “High school students are well positioned to improve rates of bystander CPR initiation in the United States, and their engagement could reduce deep disparities in regional rates of survival of out-of-hospital cardiac arrest through early initiation of bystander CPR.”

Many states require CPR-certified personnel in each school, and others require at least on AED, but typically these are measures geared for adults, not students. The Pascack Valley Regional High School District in New Jersey goes beyond training just staff and annually trains and certifies all freshmen and juniors in CPR and bleeding control during health classes.

Bleeding-control training has seen an uptick in schools over the past several years as well. Texas this year required “a traumatic injury response protocol in place which includes bleeding-control kits in all schools.” While other states don’t go as far, tens of thousands of schools across the country have trained their staff in bleeding-control techniques and provided Stop the Bleed kits for classrooms and common areas. Again this training has been primarily for staff, but it could easily be transitioned for students

While the stroke survey results might be disheartening, there are easy fixes. If teenagers and young adults can learn the signs and symptoms of stroke and use this information to activate the 9-1-1 system for rapid response and treatment of CVA and TIA patients, more lives can be saved. There would be no better place to provide this education than health classes in U.S. high schools.

Barry A. Bachenheimer, EdD, EMT/FF, is a career educator and college professor. With a fire and EMS career of over 34 years and counting, he is a frequent contributor to EMS World.