Establish baseline
Confirm level of consciousness and orientation. Ask about weakness, numbness, tingling, pain, headache, trauma, or the exact time symptoms began.
How → Why → Practice
Compare both sides, identify neurologic or limb threats, and document objective findings.
Practice facial movement, speech, arm drift, grip strength, lower-extremity movement, sensation, and distal pulse-motor-sensation assessment.
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Lesson 1
HOW: Perform a focused motor and sensory assessment
Explain each request, compare left with right, protect injured extremities, and repeat the exam after movement, splinting, or a change in condition.
Observe face and speech
Ask the patient to smile or show teeth. Listen for slurred, inappropriate, or absent speech and compare facial movement on both sides.
Test upper extremities
Assess arm drift when appropriate, compare hand grips, and observe whether each arm moves equally. Do not force movement through suspected injury.
Test lower extremities
Compare movement and strength with foot pushes and pulls or another approved method. Note inability, weakness, pain limitation, or asymmetry.
Check sensation and distal PMS
Compare light-touch sensation side to side. For injured limbs, document distal pulse, motor function, and sensation before and after splinting.
Localize, trend, and report
Determine whether the pattern is focal, generalized, or isolated to an injured limb. Record last-known-well time when stroke is possible and reassess during transport.
Compare sides. A subtle difference between left and right may be more important than the absolute strength of either side.
Lesson 2
WHY: Understand abnormal motor and sensory patterns
Weakness or sensory loss may arise from stroke, spinal injury, limb trauma, metabolic illness, intoxication, or generalized critical illness.
Focal deficit
One-sided facial droop, arm weakness, sensory loss, or speech change is concerning for a focal neurologic emergency such as stroke.
Generalized weakness
Symmetric weakness may occur with hypoglycemia, infection, dehydration, medication effects, toxic exposure, or other systemic illness.
Spinal pattern
Weakness or sensory change below a suspected spinal injury, especially when bilateral, is a high-risk finding requiring careful movement and rapid transport.
Distal neurovascular compromise
Absent pulse, worsening numbness, or inability to move distal to an injury may indicate limb-threatening compromise. Reassess before and after splinting.
Pain-limited movement
A patient may not move because of pain rather than neurologic loss. Document what was attempted, what limited the exam, and whether sensation and pulse remain intact.
Time matters
When stroke is possible, document the last time the patient was known normal and communicate the finding early so the receiving system can prepare.
Quick knowledge check
Which finding is most concerning for an acute focal neurologic emergency?
Full scenario mode: complete this assessment for the active patient. Teaching sections and patient changes are locked until you leave the scenario.
Lesson 3
PRACTICE: Assess, classify, act, and document
Review the presentation, perform the focused exam, classify the result, identify the dominant pattern, select the immediate EMT priority, and document objectively.
Random patient
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Example PCR documentation
Training content only. Follow your approved education, medical direction, and local protocols.