Richmond Ambulance Authority became Virginia’s first government-funded emergency medical service to train staff on advanced stroke detection, implementing the American Heart Association’s Essential Stroke Life Support program in December 2025. The initiative equips approximately 175 paramedics and EMTs with the BEFAST protocol – assessing balance, eyes, face, arms, speech, and symptom timing – allowing strokes to be identified faster.

During an untreated stroke, 1.9 million neurons die every minute, according to NIH-funded research. Patients receiving early treatment for this brain injury show remarkably improved outcomes, with some studies reporting 40% relative increases in independent ambulation.

With reports showing that approximately 205,000 annual EMS activations nationwide are related to suspected stroke, prehospital detection is critical. Stroke continuing education mandates, though, remain limited. States with requirements include Massachusetts, New Jersey, Virginia, California, Illinois, North Carolina, and Texas. New Jersey law N.J.S.A. 27:5F-27.1 mandates that “each emergency medical services [EMS] provider… shall incorporate training on the assessment and treatment of stroke patients”.

“Time is tissue,” explained RAA Training Coordinator Harold Mayfield. “[Most] brain tissue does not regenerate. The sooner we identify and treat, the better the outcome.”