EMT Patient Assessment Scenarios: Four Medical and Trauma Calls, Worked Through
Four worked EMT patient assessment scenarios, two medical and two trauma, with the findings each question reveals, the key decisions, and the mistakes each call is built to catch.
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Patient assessment is easiest to learn from a real patient and hardest to practice without one. These four practice scenarios are written out as worked examples: two medical calls and two trauma calls, each run through the same backbone of scene size-up, primary assessment, history, secondary assessment, vital signs and reassessment. Each finding appears only when the assessment asks for it, the key decisions are stated as principles, and every call ends with what it tests and the mistakes students most often make on it.
How to use these scenarios
Read the dispatch and the first look, then stop. Before you read the steps, say out loud what you would do and ask next, in order, and what would make this patient high priority. Then compare. The point is not to match every line but to notice the step you skipped. The order each call follows is the one the Patient Assessment in EMS guide sets out, and each scenario points to the guide that covers its key step in depth.
- Scene Size-Up and Primary Assessment: the five parts of the size-up, X, A, B, C, D, E, and the priority decision.
- OPQRST: the complaint, letter by letter.
- SAMPLE History: the patient, letter by letter, including where the history comes from when the patient cannot give it.
- DCAP-BTLS: what you look and feel for in a trauma exam, region by region.
- Geriatric Patients in EMS: why an older adult's presentation is so often atypical.
Medical scenario 1: chest pressure in a parking lot
A responsive medical patient, so the history comes before the focused exam. The call looks simple, and the test is whether you recognize how sick he is from his skin and his story rather than from one number.
A 64-year-old man with chest pressure
Given
- Dispatch: a 64-year-old man with chest pain in the parking lot of a garden center. His wife is the caller.
- Scene: daytime, cars moving slowly through the lot. He is sitting sideways in the passenger seat of his car with the door open. Several bags of mulch are in the open trunk and two more are on the ground.
- First look: pale and sweaty, sitting upright with one hand pressed flat on his chest. He talks to you in full sentences.
Steps
- Scene size-up: park so the ambulance shields you from traffic in the lot, gloves on, one patient, nature of illness chest pain. If your system sends an advanced provider to chest pain, request one now rather than after the assessment.
- Primary assessment: sick. Alert and oriented; chief complaint "pressure in my chest." Airway open. Breathing a little fast but adequate. Radial pulse present, fast and regular. Skin pale, cool and moist. No bleeding.
- Priority decision: chest pain with signs of poor perfusion makes him a high-priority patient. Plan to move him soon, and do the rest of the assessment around that plan.
- OPQRST: Onset: about 25 minutes ago, lifting bags into the trunk, built over a minute or two. Provocation: no better sitting down, no change with a deep breath. Quality: "like somebody sitting on me." Region and radiation: center of the chest, into the left shoulder and jaw. Severity: 7 of 10. Time: constant since it started.
- SAMPLE, starting with symptoms: nausea and some shortness of breath. Allergies: codeine, which he says made him vomit. Medications: a blood pressure pill and a cholesterol pill; asked directly, no blood thinners, no inhalers, nothing taken for this pain. Past history: high blood pressure and cholesterol. Last oral intake: coffee and toast at breakfast. Events: loading heavy bags in the sun.
- Focused exam, cardiovascular and respiratory: breath sounds clear on both sides, no swelling of the legs, neck veins not distended, no injury to the chest wall.
- Baseline vital signs: heart rate 104 and regular, blood pressure 152/94, respirations 22, pulse oximetry 96% on room air, skin pale, cool and moist, pupils equal and reactive. A blood pressure that is not low does not cancel what his skin is telling you.
- Treatment principles: position of comfort, oxygen only if indicated by your protocol, and aspirin per protocol after confirming he is not allergic to it and has no reason it would be unsafe. Acquire a 12-lead early where your protocol and your level allow, because the receiving facility needs it early.
- Movement: he does not walk to the stretcher. Exertion is what started this.
- Reassessment: as an unstable patient, about every 5 minutes and after every intervention. Repeat the primary assessment, the vital signs and the pain score, and ask about the radiation again. His second set and pain score of 6 of 10 go in the report beside the first.
- Handoff: lead with the headline, then give the OPQRST in one sentence, the onset time and what was given and when.
Field impression: chest pain of possible cardiac cause, high priority. The history and the skin decide it, not the blood pressure. Move him with as little exertion as possible.
Training aid only. Verify every value against your local protocol and medical direction before acting on it.
What this call tests, and common mistakes
It tests whether you make the priority decision at the end of the primary assessment and act on it, and whether your OPQRST is complete enough that the receiving clinician hears the onset, the radiation and the time in one breath.
- Letting him walk to the ambulance because he looks steady.
- Being reassured by a blood pressure that is not low and a pulse oximetry reading that looks fine.
- Asking "is it crushing?" instead of "what does it feel like?", which plants the word.
- Missing the radiation because he did not mention it and nobody asked.
- Asking about allergies without asking what the reaction was.
- Recording one pain score instead of a trend.
Medical scenario 2: an older adult who is not herself
An altered medical patient, so the order bends: a rapid full-body exam, then vital signs, then the history from family and the scene. The test is whether you treat new confusion as a symptom and find out what normal is for her.
An 82-year-old woman with new confusion
Given
- Dispatch: an 82-year-old woman "not acting right." Her son is the caller.
- Scene: a single-story house, warm inside, the television loud. Her son meets you at the door. On the kitchen counter are several medication bottles and a weekly pill organizer with yesterday's and today's compartments still full.
- First look: in a recliner under a blanket, drowsy, picking at the edge of the blanket. She opens her eyes when you speak to her and mumbles.
Steps
- Scene size-up: safe, gloves on, one patient, nature of illness altered mental status. Turn the television down. Think now about how you will move her, and whether you need more hands.
- Primary assessment: sick. Responds to verbal stimulus on AVPU and cannot give a chief complaint. Airway open. Breathing a little fast, adequate. Radial pulse present, fast and regular. Skin warm and dry. Disability: pupils equal and reactive, moves all four limbs, and a glucose check because her mental status is altered.
- Priority decision: altered responsiveness makes her a high-priority patient.
- Rapid full-body exam, because she cannot give a reliable history: no sign of a head injury, no bruising that suggests a fall, no deformity, legs equal in length and not rotated. Dry mouth and tongue. No medication patch, no rash. Her brief is soiled and smells strongly of urine.
- Baseline vital signs: heart rate 112, blood pressure 104/62, respirations 24, pulse oximetry 93% on room air, temperature 99.1°F, blood glucose 138 mg/dL, and her son says her usual blood pressure is around 150 at her doctor's office, so this one is low for her.
- History from her son. Baseline: lives alone, does her own shopping and a crossword every day, and was completely herself on Sunday. When he spoke to her yesterday morning she was normal; this morning she was not. That is the time last known normal.
- SAMPLE, from her son and the counter. Symptoms: two days ago she said it burned when she urinated and she kept needing to go, and she has barely eaten since. Allergies: sulfa drugs, a rash. Medications: a blood pressure pill, a water pill and a thyroid pill, the last two days missed. Past history: high blood pressure, an underactive thyroid. Last oral intake: unknown. Events: no known fall.
- Delirium or dementia: the change is sudden, her attention comes and goes, and her baseline is independent. Treat it as delirium, a medical emergency until proven otherwise.
- A normal glucose rules out one cause, not all of them. A stroke screen shows no facial droop and no arm drift; record it with the time last known normal, and do not treat it as ruling a stroke out.
- Treatment principles: oxygen if indicated by your protocol, keep her comfortable and warm, request an advanced provider where your protocol calls for one, and bring the bottles and the pill organizer.
- Reassessment: about every 5 minutes. Responsiveness, breathing, skin and vital signs each time, and compare the heart rate and blood pressure with the first set.
- Handoff: her baseline, the time last known normal, the source of the history, the medication list with the missed doses, and the findings in order.
Field impression: acute altered mental status in an older adult, possibly from infection and dehydration. High priority. The finding that matters most is the change from her baseline, which only her son could supply.
Training aid only. Verify every value against your local protocol and medical direction before acting on it.
What this call tests, and common mistakes
It tests whether you assess an altered patient in the right order, get the history from the people and things around her, and read her numbers against her own normal rather than a textbook's. The Geriatric Patients in EMS guide covers the atypical presentations behind every step of this call.
- Assuming the confusion is dementia or old age without asking anyone what she is like normally.
- Stopping at a normal glucose, as if it explained the call.
- Reading a blood pressure of 104 as fine without asking what her usual pressure is.
- Not establishing a time last known normal.
- Leaving the bottles and the pill organizer on the counter.
- Talking about her to her son as though she were not in the room.
Trauma scenario 1: a fall onto an outstretched hand
A trauma patient with an isolated injury and no significant mechanism, so a focused exam is the right exam. The test is earning that decision rather than assuming it, and checking the limb properly before and after you splint it.
A 23-year-old woman with a wrist injury
Given
- Dispatch: a 23-year-old woman who fell at a skate park, possible arm injury.
- Scene: daytime. She is on a bench at the edge of the park with a friend, wearing a helmet and inline skates. Skaters are still using the park around you.
- First look: alert and upset, holding her right forearm against her body with her left hand. Normal color.
Steps
- Scene size-up: position yourselves out of the skaters' path, gloves on. Mechanism: she caught a wheel and fell forward onto her outstretched right hand from a rolling start. One patient. No other resources needed so far.
- Primary assessment: not sick. Alert and oriented; chief complaint "my wrist." Ask directly whether she hit her head or blacked out: she says no and her friend agrees, and the helmet is unmarked. Airway, breathing and circulation normal. A scraped right palm with minor oozing only.
- Priority decision: stable. A healthy young adult, a fall without a significant mechanism, no head strike and a normal primary assessment, so a focused exam of the injured area is appropriate. Any of those changing would change the exam.
- OPQRST for the pain: Onset: at the fall, about 15 minutes ago. Provocation: any movement of the hand makes it worse; holding it still helps. Quality: "a deep ache, sharp when it moves." Region and radiation: just above the wrist, not radiating. Severity: 7 of 10. Time: constant.
- SAMPLE: Signs and symptoms as above. Allergies: none. Medications: asked directly, an oral contraceptive and nothing else. Past history: none. Last oral intake: water and a granola bar an hour ago. Events: she caught a wheel on a crack; no dizziness or anything else before she fell.
- Focused exam with DCAP-BTLS: deformity and swelling of the right forearm just above the wrist, tender to touch, abrasion on the palm. Check the joint above and the joint below, then ask what else hurts: her left knee stings, and exposing it shows a superficial abrasion only.
- Distal pulse, motor function and sensation in the right hand before you splint: radial pulse present, fingers move on request, and she can feel you touch each fingertip. Record each one.
- Baseline vital signs: heart rate 96, blood pressure 128/78, respirations 18, pulse oximetry 99%, pain 7 of 10.
- Treatment principles: remove her rings and watch before the swelling makes that impossible. Splint in the position found per protocol, immobilizing the joint above and the joint below, then cold and elevation per protocol. Pain management per protocol, including an advanced provider where your system offers one.
- Distal pulse, motor function and sensation again after splinting, and record that you checked both times.
- Reassessment: as a stable patient, about every 15 minutes and after every intervention, including the circulation beyond the splint and her pain score.
Field impression: isolated, closed right wrist injury, possible fracture. Stable. A focused exam is enough here because the mechanism, her age and her primary assessment all support it.
Training aid only. Verify every value against your local protocol and medical direction before acting on it.
What this call tests, and common mistakes
It tests whether you can justify a focused exam, the decision the DCAP-BTLS guide describes for an isolated injury with no significant mechanism, and whether your extremity assessment is complete on both sides of the splint.
- Skipping the primary assessment because the injury is obvious.
- Not asking whether she hit her head, or why she fell.
- Checking distal pulse, motor and sensation before the splint and not after, or after and not before.
- Immobilizing the wrist without the joint above and the joint below.
- Leaving rings on a hand that is about to swell.
- Never asking what else hurts, and missing the second injury.
Trauma scenario 2: a side-impact collision
A trauma patient with a significant mechanism, so a rapid head-to-toe exam comes before packaging, and the scene itself needs managing. The test is letting the mechanism and the trend make the decision before any single reading does.
A 38-year-old driver in a side-impact collision
Given
- Dispatch: a two-vehicle collision at an intersection, one patient reported. Fire and law enforcement are also dispatched.
- Scene: a sedan struck on the driver's side by a pickup. The driver's door is pushed in and both front airbags have deployed. No smoke and no smell of fuel. The pickup driver is standing beside his truck. Law enforcement is arriving; fire is a couple of minutes out.
- First look: the sedan's driver, a 38-year-old man, is still belted in his seat. He is awake, anxious, holding his left side and breathing quickly.
Steps
- Scene size-up: park to shield the scene; high-visibility vests, gloves and eye protection for the glass. Side-impact intrusion suggests hidden injury. Two patients: the pickup driver needs his own assessment. Resources: fire for extrication, law enforcement for traffic, an advanced provider where your protocol calls for one, and another unit if your system needs one for the second patient.
- Access: your partner gets in through a rear door and holds manual stabilization of his head per protocol while you talk to him through the window.
- Primary assessment: sick. Alert and oriented; chief complaint "my left side, when I breathe." X: no major external bleeding. A: open, talking. B: fast and shallow because it hurts, breath sounds on both sides, no paradoxical motion. C: radial pulse fast; skin pale, cool and moist. D: alert, pupils equal, moves all four limbs.
- Priority decision: a significant mechanism and signs of shock make him a high-priority patient. Plan a rapid extrication with fire, and keep time on scene short.
- Rapid DCAP-BTLS exam before packaging. Head: left temple laceration, bleeding controlled. Neck: trachea midline, neck veins flat. Chest: seat belt mark, left lower ribs bruised and tender. Abdomen and pelvis, as far as access allows, completed as soon as he is out: left upper quadrant tenderness with guarding; pelvis stable, assessed once, gently. Extremities: pulse, motor, sensation in all four.
- Spinal motion restriction per protocol, decided by the mechanism and the findings. The back is checked as he is moved, so it is not missed altogether.
- Baseline vital signs, once he is in the ambulance: heart rate 118, blood pressure 112/70, respirations 26 and shallow, pulse oximetry 95%, skin pale, cool and moist. Expose him fully now, then cover him and keep him warm.
- SAMPLE, en route: Allergies: none. Medications: asked directly, none, and no blood thinners. Past history: none. Last oral intake: lunch about two hours ago. Events: driving through the intersection when the truck hit his door; no dizziness or chest pain before the crash.
- Treatment principles: oxygen if indicated by your protocol, keep him warm, treat for shock per protocol, and notify the receiving facility early. Where he goes is set by your protocol and your regional trauma triage guidelines.
- Reassessment: about every 5 minutes. The second set shows heart rate 128 and blood pressure 104/70: a rising heart rate and a narrowing pulse pressure. Neither number alone looks alarming; the trend shows a patient getting worse, and it goes in the report as a trend.
- A slower, complete secondary exam en route if time allows, never at the cost of reassessment.
- The pickup driver: Someone assesses him. If he declines care, your service's refusal process applies, and that includes an assessment and a judgment of his capacity. "I'm fine" at a collision is a statement to document, not an assessment.
Field impression: blunt chest and abdominal trauma with signs of shock, possible internal bleeding. High priority. The mechanism and the trend made the decision, not the first blood pressure.
Training aid only. Verify every value against your local protocol and medical direction before acting on it.
What this call tests, and common mistakes
It tests the trauma assessment at speed: managing a scene, a rapid exam that looks for every other life threat before you move the patient, and reassessment that reads a trend. The DCAP-BTLS guide covers each region, and the Patient Assessment in EMS guide explains why a mechanism is a reason to look harder.
- Being reassured by the first blood pressure.
- Treating the seat belt mark as a bruise rather than as a sign of where the force went.
- Rocking the pelvis, or checking it more than once.
- Spending time on the scalp laceration before the rapid exam is finished.
- Forgetting the second patient because he is standing up.
- Taking one set of vital signs and calling it an assessment.
Calculate a shock index from a heart rate and a systolic pressure
What all four calls have in common
- Every call starts with a scene size-up and a primary assessment, including the one with an obvious wrist injury.
- The primary assessment ends with a priority decision, and the rest of the call is built around it.
- Responsive medical patients give their own history first; altered medical patients and trauma patients with a significant mechanism get a rapid full-body exam first.
- OPQRST describes the complaint and SAMPLE describes the patient. A patient who cannot answer still has a history.
- The first set of vital signs is a baseline. The trend is what tells you the patient is changing.
- A field impression is a working answer, and the next finding can change it.
Score a level of consciousness you can repeat on reassessment
Practice handing your assessment over in a structured report
Reading a call is not running one
These scenarios are for practice reading. On paper every finding arrives when you ask for it and in a sensible order, and you can look back up the page. On a real call, or a run-through with a partner playing the patient, nobody hands you the next step, the patient answers the question you did not ask, and the findings you never looked for stay hidden. Use the worked versions to learn the shape, then practice saying each step yourself, out loud and in order, until you no longer need the page.