One-Pager
NREMT Medical Assessment Skill: Step by Step
The EMT medical assessment in order: scene, primary survey, OPQRST and SAMPLE, focused exam, vitals, treatment and handoff
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NREMT medical assessment: the order
The NREMT medical assessment station tests whether you can take a good history from an ill patient, examine the body system that matches the complaint and start the right treatment. Most of the score is in the questions you ask, so practice them until they come out in order.
- Protective equipment, scene safety, number of patients, nature of illness, more help if needed.
- General impression and primary survey: mental status, airway, breathing, circulation.
- Transport decision: critical or not?
- History of the present illness: OPQRST.
- Past history: SAMPLE.
- Focused secondary exam of the affected system.
- Vital signs, treatment, reassessment and a short report.
Primary survey for an ill patient
- Mental status: AVPU. Altered? Check a blood glucose; under 60 mg/dL is hypoglycemia.
- Airway: open and clear? Position, suction, adjunct as needed.
- Breathing: rate, effort, accessory muscles, how many words per breath. Oxygen to an SpO2 of 94 to 98%.
- Circulation: pulse rate and quality, skin color, temperature and moisture.
- Say the priority: unstable patients get treated and moved; the rest of the history happens en route.
History: OPQRST and SAMPLE
| Letter | Ask |
|---|---|
| Onset | What were you doing when it started? Sudden or gradual? |
| Provocation | What makes it better or worse? |
| Quality | Describe it: pressure, sharp, burning, tearing? |
| Radiation | Does it move or spread anywhere? |
| Severity | Zero to 10, how bad is it now? |
| Time | When did it start? Has it changed? |
| Signs and symptoms | What else are you feeling? |
| Allergies | Medicines, foods, latex? |
| Medications | Prescription, over the counter, recent changes; bring the bottles |
| Past history | Heart, lung, diabetes, seizures, surgeries; pregnancy if possible |
| Last oral intake | When did you last eat or drink? |
| Events | What led up to calling 911? |
Focused exam by complaint
| Complaint | Look at | EMT treatment to consider |
|---|---|---|
| Chest pain | Skin, breath sounds, pulses, 12-lead if available | Aspirin, help with own nitro, oxygen if SpO2 under 94% |
| Shortness of breath | Work of breathing, breath sounds, edema | Oxygen, help with own inhaler, CPAP if allowed |
| Altered mental status | Glucose, pupils, breath odor, medical tags | Oral glucose if awake and can swallow |
| Stroke signs | Face, arm drift, speech, last known well time | Glucose check, rapid transport, notify |
| Abdominal pain | Tenderness, distension, guarding | Position of comfort, nothing by mouth |
| Allergic reaction | Airway swelling, wheeze, hives, low BP | Epinephrine auto-injector per protocol |
Vitals, treatment and handoff
- Full set of vitals: pulse, BP, respirations, SpO2, mental status; glucose when indicated.
- Give treatment within EMT scope and say why you are giving it.
- Reassess after every treatment; stable patients get at least two sets of vitals.
- Report: age, complaint, OPQRST highlights, pertinent SAMPLE, vitals, treatment and response.
In depth
The one-page summary above is what the PDF prints. These sections go further.
Practice scenarios with what each one tests
| Scenario | What the history should uncover |
|---|---|
| 58-year-old, pressure in the chest for 30 minutes | Radiation, sweating, cardiac history, erectile dysfunction drugs before nitro |
| 70-year-old with COPD, worse breathing for 2 days | Home oxygen, inhaler use, fever, sputum change |
| Diabetic found confused | Last insulin dose, last meal, glucose reading |
| Sudden weak arm and slurred speech | Exact last known well time, blood thinners |
| Hives and throat tightness after eating | Known allergy, own auto-injector, airway symptoms |
| Young woman with lower abdominal pain | Last menstrual period, possible pregnancy, bleeding, dizziness |
Common mistakes
- Running OPQRST on a patient who is not breathing adequately. Fix the primary first.
- Forgetting to ask about medications, the most useful SAMPLE item in older patients.
- Taking one set of vitals and never repeating it.
- Examining everything instead of the system that matches the complaint.
- No transport decision stated.
Exam pearls
- The first question after the primary survey: "What is bothering you most today?"
- Any altered patient gets a glucose check.
- For possible stroke, the clock time last known well matters more than any other answer.
- Bring the medication bottles; they tell the hospital the history.
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Sources
- National Association of State EMS Officials. National Model EMS Clinical Guidelines, Version 3.0. March 2022. Universal Care; Chest Pain/ACS; Hypoglycemia; Suspected Stroke. Link
- National Registry of Emergency Medical Technicians. Updated EMR and EMT Certification Examinations (BLS psychomotor process set by each state). Accessed October 28, 2026. Link