As I mentioned before, the new AMPDS protocols (the thing that tells call takers what to ask) come in very soon. I haven’t had my training yet but lots of the others have, and on the whole they look great – less potential for red calls to people with flu, easier to understand terms (eliminating the dreaded “I don’t know, I’m not a doctor”) and appropriate questions for scenarios that weren’t covered before (like epileptics who feel they are about to have a fit).

There is one thing that made me laugh, though.

Previously, the identification of strokes was a bit hit and miss – we simply triaged something as a stroke if someone said they thought it was a stroke, or if the call taker thought it sounded a bit like a stroke. Now we have to do the FAST test – as in that advert where the woman has a fire in her head! So, for “Face”, we ask the patient to smile and the caller tells us what happens. For “Arms”, we ask them to raise their arms, and for “Speech”… here’s the good bit… we make them repeat the following phrase:

“The early bird catches the worm”!

Can you imagine it? We live in London, where a sizable percentage of our callers don’t speak English. Many of their elderly patients – the people most likely to be having strokes – don’t speak a word of English. I would hazard a guess that “the early bird catches the worm” is a piece of idiomatic speech that doesn’t translate too well into Bengali/Farsi/Turkish and confusion and chaos is going to reign as soon as we start doing this. I can just imagine the reactions: “My father is having stroke and you are making him recite proverb? Just send ambulance!” It’s never going to work. Someone didn’t think this through. Or more likely, someone in the middle of America where people with English as a second language are virtually unheard of thought this up.

With any luck, they will let us replace “the early bird…” with a universally understood phrase of our choice. Something like “I am not a doctor” or “Just send the ambulance” would probably do.

Published Mar 25, 2009 - 27 Comments and counting

27 Comments on “Call Takers and the FAST Test”
  1. Happy Medic Says:

    Please repeat the following statement, “I’m a big boy and will get myself to the A&E.”

    If they’re silent, hang up.
    If they answer, say, “OK” and hang up.
    If they slur, red call.

    It’s just that simple. ;P


  2. Nickopotamus Says:

    We go with “baby hippopotamus” and “British Constitution”. Less chance of translation problems, but still face the “why are you asking me to say stupid things?” issue.

  3. Erin Says:
    You are correct to say that the Midwest region of the U.S. has the smallest percentage of people who speak another language than English at home — but it’s still at least 5 million people.

    I had to look it up, because I live in Chicago and I hear at least Spanish and Polish spoken every day, but I realized it might just be because this is a big city. I seldom hear anyone saying “The early bird catches the worm”, however.

  4. Suzi Brent Says:

    Come to think of it, I can’t remember the last time I heard someone say “The early bird catches the worm” in normal conversation, though I suspect now it’s wormed (pardon the bad pun) its way into my head I suspect I’m going to start saying it all the time now.

  5. Jay Says:

    Is it actually necessary to get to the speech bit if the patient can’t smile or has a mouth that’s drooped and can’t raise their arms?

    Wouldn’t that be enough to assume a stroke has occured and send an ambulance? Or do you have to complete the whole thing to be “by the book” and not get into trouble with the bosses?



  6. Suzi Brent Says:

    Jay: The ambulance would be sent as soon as the caller said it was possibly a stroke or described any stroke symptoms – before the FAST test was even started. Doing the test is more to give information to the crew, categorise the call correctly and help the call taker decide what to do next. So we would definitely ask all three.

    I am not sure what happens if the patient “passes” elements of the test – we are taught that any of these symptoms alone are signs of a stroke so I imagine the call wouldn’t be downgraded unless they passed all three. I will let you know how it works when I’ve done my training!

  7. Jay Says:

    I am torn about this FAST thing – I suffer from occasional Transient Ischaemic Attacks, which *on the whole* do not require bluelighting to A&E. (I’ve been in and out enough over the years to know myself when I need to see J Random Dr *now* and when I can allow time to recover a little and then go in and see my own consultant.) I don’t want to be put in the position where well-meaning strangers send me to A&E so often (and basically needlessly) that call-takers start to think I’m crying wolf! On the other hand, I do think it’s a really good campaign in general since people are woefully undereducated about strokes. Gah.

    I’m going to have to get a ‘please do not call me an ambulance unless I am actually unconscious’ bracelet, aren’t I?

  8. AmbEMD Says:

    We’ve been using this protocol for some time, and it works ok, the wording could be better though… my main problem with it are…

    Patient refusing to smile/raise arms/ or say the phrase
    (thankfully dont have too much of a language barrier problem) patients seem to say they dont want to… what do you say to that??? Theres no option to put pt refused.

    No option for amputees (when u ask them to raise both arms above their head)

    The tool is a good idea, but has room for improvements. Callers do seem to understand now though why we’re asking them to do these 3 things thanks to the TV adverts. :)

  9. Viking 83 Says:

    Your not the only one who gets asked: ‘why all the stupid questions?’. When checking GCS in the neuro ward I’m currently on, the patient needs to be intact to the three spheres of: time, person and place. And it can lead to some painfull moments because according to the literature and hospital policy, the person can’t just know their exact location, they must know the city, county and country, and same with the time, date month and year. This is because some patients who are 15/15 on paper can repeat what they’ve heard but the minute you break the mould and ask something like ‘who’s the queen of England?’ they have no idea.
    However in my more intact patients, I often get asked: ‘why everytime you do this, you ask such stupid questions?’

  10. Jane Says:

    It could be worse – you could ask them to say “She sells sea shells at the sea shore.” ;)

  11. Erin Says:

    My area was one of the test zones for this, and I have to say, generally speaking, it works quite well. Even with the non-English. But let’s face it, everything is a struggle if their level of english is that poor and you’ll likely have the ambulance there before you get to the FAST test.

    It was always a nice way for me to point out to the people who weren’t having a stroke that they really weren’t. (after that advert, EVERYTHING was a CVA, I had one that was clearly ?MI and they were all insistent that he was having a stroke. Or the woman who was having a fit was no, no, she’s having a stroke. “Sir, is she jerking and thrashing about?”
    “Oh yeah, she’s really having a stroke.”)

    My favourite answer was when I did the smile question and heard the patient say. “I got nothing to smile about.”

    And anyway, the phrase used to be, “You can’t teach and old dog new tricks.” And that was always a barrel of laughs :S

  12. katie Says:

    Why on earth would you use an idiom for an aphasia anyway? Well-rehearsed phrases are often preserved when spontaneous speech isn’t. I’d ask them to tell you what’s outside the window – unless they have fluent aphasia, you can probably tell their speech is slowed/absent/non-fluent even if you don’t speak their language.

  13. katie Says:

    gah – clearly aphasic myself today – “an idiom for aphasia” not “an aphasia”.

  14. dave m Says:

    repeat the following phrase “you just answer the phones now just send a ambulance” or “stop this call centre crap, where is my ambulance”

  15. EMD Says:

    I raised this particular point about that phrase and non-english speakers. A certain trainer informed me it’s a well known phrase in many languages. Yeah Right.

  16. benson Says:


  17. benson Says:

    am wondering about the crews response when they rock up to a patient waving both arms in the air, wearing what could be a silly looking smile on their face and reciting b******s, is it possible crew could think call taker has gone for wrong card and should be on drugs overdose card-especially if patient is in process of dissolving 4 small white tablets under their tongue at the time -as per new asprin advice!!(and before anyone asks have’nt quite worked out how that could happen)

  18. xdk927 Says:

    ok, so we use “fire-fighters are my friend.” which typically garners a deep guffaw from all at station when reciting in practice. Also “the rain in spain stays mainly on the plain” is effective.
    BUT… we’ve got asians in the northwest, hispanics in the southwest and central, French in the southeast and who knows whatelse in the northwest of the US. I actually heard an ethiopian woman yesterday say “Sorry, no speak english.” jokingly to a harrasing patient. We’re still pretty strangely international in the land of immigrants! hopefully we can be done with creating confusion for stroke patients by symply having them all say sassafrass or xyphoid process or pubic symphosis or something to that effect… quick and painless. sorry for the american screw ups. We’ll try to do better, I promise!

  19. Ray Says:

    Surely the issue about English as a second language occurs in many other conditions? Isn’t there any existing national advice for those that could help here?

  20. Suzi Brent Says:

    Sorry Ray, not sure I understand what you mean. Strokes are the only condition in which we need to assess someone’s speech over the phone.

  21. Ray Says:

    I was thinking of those conditions that are sometimes said to mimic stroke. (Maybe the mimickry is only in the face and arms difficulties?)

  22. Suzi Brent Says:

    They’d probably fail the FAST test and be triaged as a stroke by the EMD, but either the ambulance crew or the doctors would discover it wasn’t a stroke. Any patient with strokelike symptoms is treated as a stroke until proven otherwise, we don’t try to diagnose any further than that over the phone.

  23. kingmagic Says:

    The problem with the speech part of the test is that it is discriminating against those who cant speak English.

    What we need to do in the ambulance service is to learn every language in the world in an effort to be inclusive.

    It is our fault that we speak English and we should publicly apologise to all our callers at once. In fact we should compensate them all for putting them through the speech test in the first place.

    We should hand over all our money and chattels to non English speakers (apologies for using a capital letter in english, will not do it again).

    This all started with Florence Nightingale during the Crimean War, she should have encouraged the wounded to learn different languages in an effort to kick start multicultarism and inclusivity earlier.

    Shame on the NHS!

  24. anon Says:

    Very interesting website! I know I'm late to the train ;-) and everyone's left, but as I read thru this one I'm wondering about deaf or even HOH callers. Obviously, most deaf people are going to call in another way, via relay or TTY, but existing speech disorders from either hearing or other issues are certainly present in the population? Or take someone like me — I speak fine but have difficulty understanding things on the phone. I assume aspects of your training cover these issues as well?

    Good luck with your book, I'll have to look around for it when it comes out next year :)

  25. jol Says:


  26. hiodc Says:

    hi bebe

  27. terry alexander Says:

    [...] as Captain Rhodes. Jarlath Conroy as William McDermott. Anthony Dileo Jr. as Pvt. Miguel Salazar …Nee Naw – Call Takers and the FAST TestI haven’t had my training yet but lots of the others have, and on the whole they look great – less [...]

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    Nee Naw was a blog about life in the London Ambulance Service control room. It was written by Suzi Brent from 2005 to 2010. The blog is no longer being updated, but the archives will remain here.
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