EMT medical emergencies, organized by what you decide at each step
12 chapters
·
about 21 min read
·
free
Medical calls look like hundreds of conditions, yet you rarely get a diagnosis in the field and rarely need one. You need a fixed order of questions. Is the scene safe? Is anything killing this patient right now? What does a focused history add? What does the whole picture mean for how fast you move, and to which hospital? This guide teaches that frame, then runs each kind of emergency through it. Orientation for study, not clinical advice, and not affiliated with the National Registry of Emergency Medical Technicians. An emergency medical technician (EMT) works under medical direction and local protocol, and those govern real care. This guide covers medical emergencies at EMT scope; hands-on technique, drug doses and resuscitation figures stay with your course.
Each chapter opens with the short version. Tap one to read the detail.
The frame: scene, survey, history, decision
~2 min
Every medical call runs in one order: scene first, then a primary survey for life threats, then a focused history and exam, then a transport decision you keep revisiting. Many assessment errors are good steps done at the wrong time.
Think of assessment as a funnel, where each question opens only after the last one is answered.
Scene comes first. Is it safe for you, what protection fits, how many patients are there, and should you ask for more help now? The primary survey comes next: massive bleeding, airway, breathing and circulation, with a quick read of responsiveness, and you deal with each threat as you meet it. Someone unresponsive and not breathing normally moves straight to a pulse check and, if there is none, to resuscitation. Only then does the focused history begin. OPQRST (onset, provocation, quality, radiation, severity, time) describes the symptom. The sample history, named for its initials, describes the person: signs and symptoms, allergies, medications, past illness, last intake and events.
The fourth step is the one beginners forget is a step. What does this picture mean for transport? A patient who looks sick, whatever the cause, earns less scene time and an earlier call to the hospital.
The classic trap is taking a careful history from someone barely moving air. Its mirror image is trusting one reassuring number: a normal oxygen reading can sit beside a patient who looks terrible, and the patient wins that argument.
Picture a man on his kitchen floor, breathing fast, whose wife says he has not been himself since lunch. That sentence is a finding, because it measures him against his own normal. You have already read the room and his breathing by then, and you repeat your checks on the way in.
Rule: ask the four questions in order on every call, and take the hands-on steps inside each one from your course and local protocol.
Airway and oxygen: three problems that look like one
~2 min
A blocked passage, too little air moving, and too little oxygen in that air are separate failures. Each has its own tools, and an oxygen mask answers only the third.
Ask three questions in sequence. Is the passage open? Is enough air moving through it? Is that air rich enough in oxygen?
Every airway tool you will learn belongs to one of those layers. Positioning and airway adjuncts hold the passage open, while suction and choking maneuvers clear it. A bag-valve mask moves air for someone who cannot move enough alone. A nasal cannula and a non-rebreather mask only enrich air the patient is already pulling in. Continuous positive airway pressure (CPAP), where protocol allows it, sits apart: it helps an alert patient who is breathing and can guard their own airway but is losing the fight.
The most expensive beginner error is treating the third layer when the second has failed. A mask on someone taking tiny, ineffective breaths looks like care and delivers very little. The opposite error comes with the bag itself: squeezing harder or faster sends air into the stomach and invites vomiting.
Anatomy can change the route too. A child's proportions mean an adult's positioning habit can work against you, and some patients breathe through an opening in the neck.
Consider a woman gasping after past throat surgery, while a crew struggles with a face mask and her chest never rises. One look at her neck changes everything, because that opening may be her only path to the lungs, so that is where you clear and ventilate, by the method your course teaches. An airway you cannot manage is also a reason to call for help early and shorten the scene.
Rule: find the failing layer before you pick a tool, and learn sizes, flows, rates and time limits from current training, not from a page.
Breathing emergencies: judge the work, not just the rate
~2 min
Breathing failure shows in effort, depth and mental state as much as in a number. Lung sounds suggest where the trouble sits, and a patient who is growing quiet may be getting worse rather than better.
Lung sounds work as a rough map. Stridor, harsh on the way in, points high in the airway and tends to be the most urgent. Wheezes come from narrowed lower airways, as in asthma and chronic obstructive pulmonary disease (COPD), and anaphylaxis or heart failure can produce them too. Crackles suggest fluid in the small air sacs, as in heart failure or pneumonia. Clear lungs in a suddenly breathless patient are a clue of their own, not a reassurance.
Then read the person. Can they finish a sentence? Are they sitting bolt upright because lying flat is unbearable? That fits heart failure, though severe asthma and COPD can do the same. An oxygen target for a COPD patient comes from protocol, and fear of oxygen is never a reason to leave a hypoxic patient short of it.
The dangerous misreading runs in two directions. A struggling asthmatic whose wheeze fades may be moving too little air to make noise. A fast-breathing patient with clear lungs gets labeled anxious.
Take a woman two weeks after knee surgery who turns breathless within minutes, with a fast pulse, pain on deep breaths and a sense of dread. It looks like panic. A clot that has traveled from a leg vein to the lung can look just like that, and her recent surgery is what moves your suspicion. A heart problem or pneumonia could fit as well, and you do not have to sort them out or prove anything to act. You support her breathing, tell the hospital why you are worried, and go.
Rule: read effort and alertness before the number, and treat anxiety as the last explanation you reach, never the first.
The heart: a blocked pipe, a wrong rate, or a stopped pump
~2 min
Cardiac calls sort into three problems: a blocked artery, often with symptoms that are not classic; a rate too fast or too slow to perfuse the body; and arrest, where the pump has stopped. Each sets a different pace.
Start with the blocked pipe. Crushing pain is only one form a heart attack takes. It may be heaviness in the chest, or discomfort in an arm, the back, the jaw or above the belly button. Breathlessness is more common in older adults and unusual tiredness in women, and silent attacks occur more often in older people and people with diabetes. Pain that fades with rest suggests angina, but you cannot rule out a heart attack in the field. Your role is recognition, the medications your protocol allows, and early notice to the hospital.
A rate problem is judged by what it does to the patient. A slow pulse in a fit runner may mean nothing, while the same number with fainting and cool skin is an emergency. Pressure is similar: a value above 180/120 needs medical attention regardless, and it turns urgent when sudden headache, chest pain, trouble breathing or weakness comes with it.
A stopped pump leaves almost no time. Roughly nine of ten people who arrest outside a hospital die, often within minutes. Early cardiopulmonary resuscitation (CPR) and an automated external defibrillator (AED) are the levers that matter.
The trap is gasping. A man who collapses at the gym and takes slow, noisy breaths looks as if he is breathing, but gasping is not normal breathing. With no response and no pulse he is in arrest, whatever else caused the collapse, so you start now. Devices add a wrinkle: someone with a left ventricular assist device may have no pulse to feel at all, so judge that patient by alertness and skin, and ask the caregiver.
Rule: decide first whether the pump is working, and take compression figures, pad placement and medication limits only from current training.
Shock, sepsis, and the infections you could carry home
~2 min
Shock means organs are short of blood and oxygen, and low pressure arrives late, so you read it earlier from pulse, skin and alertness. Sepsis can look mild until it does not, and protecting yourself is decided before you touch anyone.
Picture circulation as a tank, a pump and pipes. Hypovolemic shock is an empty tank, from bleeding, burns, dehydration or severe vomiting. Cardiogenic shock is a failing pump, as after a heart attack. Septic, anaphylactic and neurogenic shock are pipes gone wide, and a massive clot in the lung blocks the line outright. Naming the type matters less in the field than seeing that shock exists.
Beginners wait for low blood pressure, but the body defends pressure for as long as it can. Restlessness or confusion, a fast pulse, sweating, pale skin and cool hands often show up while the number still looks fine.
Sepsis breaks even that picture. An ordinary infection, sometimes from a small cut, sets off an extreme response across the body. Take a 78-year-old with a recent bladder infection who is newly confused and breathing fast, with warm skin and a normal pressure. That pattern in someone with an infection is the warning, and older adults, babies and people with weak immune systems carry more risk. New confusion has other causes too, so check sugar and stroke signs where protocol allows, and move either way. A sudden high fever with severe headache and a stiff neck raises concern for meningitis.
Infection control follows the same logic as assessment: decide early. Ask how a germ could reach you, and choose protection for that route. After a needlestick or a splash, report it right away rather than at the end of the shift.
Rule: read perfusion long before the pressure falls, treat suspected shock as a reason to move, and choose protection under your agency's plan before patient contact.
Altered mental status: stroke, seizure, sugar
~2 min
A brain that is acting wrong is often short of something, such as oxygen, sugar, blood flow or normal electrical activity, or it has been hurt or poisoned. Check what can be fixed, record when it began, and keep the list of causes open rather than stopping at the first one.
Altered mental status is a symptom with a long list of causes, so the skill is refusing to close the list early. Airway, oxygen and, where protocol allows, glucose come first because they are fixable.
Stroke is a time problem. Brain cells begin dying within minutes of losing blood flow, and most strokes come from a clot. Sudden facial droop, one-sided arm weakness or strange speech is enough for suspicion. Your most useful contribution is often one fact: when the patient was last known to be normal. That fact, plus local rules on destination, drives your transport decision.
Most seizures stop on their own within two minutes. One lasting beyond 5 minutes, or repeated seizures with no waking between them, is an emergency. Move hazards away and keep the mouth empty while it runs. Confusion afterward is expected if it steadily clears.
Low blood sugar tends to come on quickly, with shaking, sweating, irritability and confusion, while high sugar usually builds over hours to days. Fainting is usually a brief drop in blood flow to the brain, but it can signal a heart problem.
Now take a man slurring outside a bar, smelling of beer. The obvious story is that he is drunk. He may also have a low sugar, a head injury or a stroke, so you check for them before you accept the story, and a small device on his belt might be an insulin pump still delivering. A blood thinner on his medication list would change how you read even a minor fall, and steroid use or sickle cell disease brings its own hidden risks.
Rule: never let the first explanation end the search, and let suspected stroke or a long seizure shorten your scene time under local protocol.
Allergy and poisoning: what got in, and what it reached
~2 min
Sort these calls with two questions: how did the substance enter, and which body system is now in trouble? Anaphylaxis shows itself in the airway and circulation, not only in a rash, and a toxic scene can make you the next patient.
The route in decides your first moves. A poison can be swallowed, inhaled, injected or absorbed through the skin, and an inhaled or absorbed one may still threaten you when you arrive. So the scene question comes first again, and sometimes the right answer is to wait for people with the right equipment.
The system reached decides the urgency. A reaction limited to itchy skin is something to watch, because it can still progress. After a likely trigger, throat tightness, wheezing, a weak pulse or fainting points to anaphylaxis, which can begin very quickly, and skin signs may be missing altogether. Delay with epinephrine is the error your course will stress, within the limits of your protocol.
Opioids act on the brain's control of breathing, so very small pupils, slow breaths and a limp body are the classic picture, though other drugs on board can change it. Moving air comes before the antidote, naloxone, which can wear off while the drug is still present. Stimulants speed everything up, sedatives slow it down, and mixed use blurs the two. Alcohol withdrawal can be deadly, so a shaking heavy drinker is a medical patient.
Consider a family of four, all with headache and nausea on a cold night, all sure it is flu. Several people sick in one building should make you think of carbon monoxide, which has no smell and can fool a standard oximeter. Your safety and fresh air come first, and a normal oxygen reading clears no one. Flu may still be the answer, but only after the air is ruled out. A poison center, at 1-800-222-1222, can help with substance-specific questions, and any effect on breathing, circulation or alertness points toward early transport.
Rule: ask how it entered before how to treat it, and never become a second patient on a scene you could have read from the doorway.
Belly, face and throat: danger without a diagnosis
~2 min
You cannot sort abdominal pain by how bad it feels, so you look for bleeding, a rigid belly and signs of shock instead. In the face and throat, a few recognition rules keep you from making things worse.
Abdominal pain punishes confidence. Severe pain may turn out to be minor and mild pain may be serious, so intensity cannot be your sorting tool. Look for what changes transport: a hard, tender belly, vomit that looks like coffee grounds or holds bright blood, black tarry stool, and the fast pulse and clammy skin that say blood is being lost where you cannot see it. You do not need to name the organ, and upper belly pain can even be the heart. Let the patient find a comfortable position and move gently.
A kidney stone is the classic false comfort. It causes severe back or side pain and is a reasonable first thought. In an older patient, though, sudden severe pain in the belly or back with dizziness and a fast heartbeat can be a ruptured aortic aneurysm. Picture a 70-year-old who insists he has passed a stone before. Look for shock before you accept his story, remember that a normal pressure does not clear him, and think about a hospital that can operate under your local destination rules.
Belly pain with shoulder pain or faintness in someone who could be pregnant should also raise the possibility of an ectopic pregnancy, which can bleed heavily inside while little shows.
The head and neck have their own short list. A chemical in the eye keeps burning until it is washed away, so irrigation starts early. A nosebleed goes better leaning forward. An upright, drooling patient with a muffled voice may have a swollen epiglottis, and a look down the throat can trigger complete blockage, so keep that patient upright and calm, leave the throat alone, and move early.
Rule: judge the abdomen by signs of bleeding and shock rather than pain alone, and learn the techniques for eyes, noses and throats from your course.
Childbirth: two patients, and one decision to deliver or move
~2 min
Most newborns need warmth, drying and stimulation, and little more. Your attention belongs on the complications that change everything: heavy bleeding, an abnormal presentation, and a mother at risk of seizures.
A pregnant patient is two patients and a timing question: will birth happen before the hospital? Crowning answers it, and a strong urge to push points the same way. Your course teaches the delivery steps; here, hold onto the decisions around them.
Newborn care is often drawn as an inverted pyramid. The wide top is warmth, drying and stimulation, which nearly every baby gets. A smaller group needs help breathing, and very few need anything more. Breathing, not the heart, is the usual problem, so the beginner's mistake is reaching for the dramatic step when the baby needs air. A score recorded in the first minutes describes how the baby is doing, and it never comes before care.
The complications are about recognition. Bright bleeding late in pregnancy with no pain suggests a placenta lying over the cervix (placenta previa). A hard, painful belly suggests a placenta pulling away from the wall (placental abruption), where blood can stay hidden, so little showing does not reassure you. You need not choose between them: both can mean shock, neither gets an internal exam, and both move quickly. An umbilical cord that comes first, or a birth that starts with buttocks or feet, means you call for help early and move quickly. Heavy bleeding after birth is judged by the mother's pulse as well as what you can see.
Take a woman five days after delivery with a severe headache and swollen hands, who assumes her pregnancy problems ended with the birth. Preeclampsia, a sudden rise in blood pressure, appears after the twentieth week of pregnancy, but in rare cases it begins only after delivery, and it can progress to seizures. Take her pressure and look for stroke signs, since a bad headache has other dangerous causes. That call ends in transport, not reassurance.
Rule: ask whether birth is imminent and what threatens either patient, then take delivery technique, cord timing and newborn figures from your course and protocol.
Children, elders and complex care: one frame, different alarms
~2 min
The frame stays the same, but the warning signs move. Children hold their numbers until they suddenly cannot, older adults may show only new confusion, and people living with home equipment have caregivers who know it better than you do.
Children let you assess before you touch them. From across the room, look at appearance, work of breathing and skin color. Their normal numbers vary with age, so use a chart, and do not read a normal pressure as safety, because a child can hold it until compensation fails. A child who looks sick goes early. In a dehydrated infant, look for no tears, few wet diapers and sunken eyes.
A febrile seizure frightens everyone and is often less dangerous than it looks. It is most likely between six months and five years, and simple ones cause no lasting harm. A first one still needs medical evaluation, and a stiff neck or extreme sleepiness raises concern for meningitis. A child still seizing when you arrive is an active seizure, whatever the label.
Older adults flip the problem, because their alarms get quieter. An infection may show as new confusion without a fever, and a long medication list can cause falls and hide a fast pulse.
Complex care widens the frame. A missed dialysis run can mean too much fluid and potassium, while the hours after one can mean low pressure and falls. Fever in someone on chemotherapy may be the first sign of a dangerous infection. A do-not-resuscitate order limits resuscitation, not all care. A service dog can generally ride along unless it would interfere with treatment, and an interpreter line beats a child translating.
Consider an injured toddler whose caregiver's story has changed twice. You treat the child first, accuse no one, write down what was said, and follow your state's reporting rules rather than investigating.
Rule: find out what normal looks like for this person from those who know them, read every number against it, and let state law and protocol settle the rest.
Behavioral calls: safety, medical causes, and the right to refuse
~2 min
Strange behavior is a symptom until proven otherwise. Keep yourself and the patient safe, look for the medical cause that a psychiatric history can hide, and treat refusal as a question of capacity.
Run the same frame, starting with the scene. Where are the exits, and is anything nearby a weapon? Space, a slow voice and one person talking do a lot of the work. If the scene turns unsafe, leaving and waiting for police is part of the job.
Next comes the search for a medical cause. Low blood sugar, low oxygen, head injury, infection and drugs can all produce aggression or strange speech. The trap is a psychiatric history, which ends the search too soon. Imagine a man with known schizophrenia who is shouting, sweaty and confused. His diagnosis may be true and also irrelevant today, because a sudden change with abnormal vital signs points toward his body. Check sugar, oxygen and temperature where protocol allows.
Restraint is where a behavioral call can turn fatal. Weight on the back and face-down positioning can stop breathing, and severe agitation with high body temperature is a medical emergency in its own right. Restraint is a last resort governed by protocol, never face-down, with someone watching breathing and pulse throughout, and that holds when police applied it. A patient who suddenly goes quiet needs immediate reassessment, because that silence can be the start of an arrest.
With possible suicide, ask directly. Federal mental health researchers report that the question itself does not raise suicidal thinking or behavior. Ask about a plan as well, since a plan and access to lethal means raise the urgency, and stay with the person.
Refusal turns on capacity. Someone who understands the situation, options and risks may decline transport, while someone hypoxic, hypoglycemic or intoxicated may not be able to make that choice. Involve medical direction as your protocol requires, and write down what you explained.
Rule: look for the medical cause before accepting a behavioral one, and let protocol and medical direction settle restraint and refusal.
Medications, medical direction and the record
~2 min
Every medication decision answers three questions in order: does this patient have the condition, could it harm them, and do you have authority to give it? The radio report and the written record then carry your thinking to the next person.
Your medication list is short and set by your state, so learn each drug by its job and its stop sign. Oxygen, aspirin, oral glucose, an epinephrine auto-injector and naloxone are the usual core, with the patient's own nitroglycerin or inhaler where assisting is allowed. Doses and limits are protocol material and do not appear here.
Three questions apply to all of them. Is the indication there? Is there a contraindication? Do you have authority, through written standing orders or a live order from a physician? Beginners see the indication and stop thinking. Take a man with chest pain and nitroglycerin in his pocket, who mentions an erectile dysfunction drug only when you ask plainly. The indication was real, and the stop sign stayed hidden until you asked. Low blood pressure is another.
Talking to medical direction is a skill as well. Repeat an order back, because radio garbles things, and speak up if it conflicts with what you see. Calling is also how you handle a patient who falls outside your written criteria, though no order stretches you past your certification.
The radio report and the chart both let the next person pick up your thinking. Lead with who the patient is and why it matters. Record what you looked for and did not find, along with what changed after each treatment. Correct errors visibly, never by erasing, and keep patient details away from photos, posts and bystanders.
Rule: answer condition, harm and authority before any medication, take the specifics from your protocol, and write down what happened afterward.
Written by Keentune. We are not affiliated with or endorsed by the organizations whose documentation informs this guide, and any linked sources belong to their respective owners.
All exam, test, and product names and trademarks are the property of their respective owners and are used here for identification and reference only. Keentune is independent study practice — not affiliated with, authorized, or endorsed by any of these organizations.