Not So FAST: Rethinking Stroke Recognition in Pre-Hospital Care with Shane Devlin and Ronan Walker

In pre-hospital care, few diagnoses carry the same urgency as stroke. But not all strokes present the way we expect, and that’s where the risk lies. In this episode, we explore the challenge of recognising posterior circulation strokes, using both clinical insight and lived experience. I’m joined by Shane Devlin, a registered paramedic and newly appointed PhD researcher focusing on posterior stroke recognition. His work builds on frontline experience and a growing body of evidence that highlights just how easily these patients can be missed.Alongside Shane, this conversation is grounded in a personal story: my brother, Ronan Walker, who suffered a posterior stroke 4 years ago in his late 30's. His presentation didn’t fit the traditional mould. There was no clear FAST-positive picture, just subtle, evolving symptoms that required a different kind of clinical suspicion.This episode sits at the intersection of science and story. We unpack the limitations of current assessment tools, the cognitive challenges clinicians face in the field, and what needs to change to improve recognition. Because in a posterior stroke, the issue often isn’t treatment, it’s getting patients to treatment in time.Shane has published both case studies and qualitative research on PCS. Both can be found here: Paramedic recognition of posterior circulation stroke: a vignette and focus group studyhttps://pubmed.ncbi.nlm.nih.gov/37674916/Not so FAST: pre-hospital posterior circulation stroke:https://pdfs.semanticscholar.org/06a1/f16d9062708b6f4ff8bb29efb7d9a61b43db.pdf⁠This episode is sponsored by PAX: The gold standard in emergency response bags.When you’re working under pressure, your kit needs to be dependable, tough, and intuitive. That’s exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They’ve partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn’t chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠