6 Medical Emergencies

Recognize the emergency and set priorities

Medical emergencies may first appear as vague symptoms such as confusion, weakness, shortness of breath, or unusual behavior rather than a clear diagnosis. EMTs identify immediate threats, provide care within their scope and local protocols, and transport the patient to an appropriate facility. Older adults and children may show atypical symptoms.

Use a systematic EMT approach

The current National Registry EMT examination organizes assessment and care across five domains: Scene Size-Up and Safety, Primary Assessment, Secondary Assessment, Patient Treatment and Transport, and Operations. Medical conditions are tested through these tasks, not as a separate examination domain.

A consistent approach is to:

1. Make the scene safe. Use appropriate personal protective equipment and assess for hazards, violence, traffic, and possible chemical or drug exposure. Request additional resources when needed.

2. Find and treat immediate threats. Assess responsiveness, airway, breathing, and circulation. Support the airway and ventilation as needed, control severe bleeding, and treat life threats before taking a detailed history. Give oxygen when indicated under local protocol.

3. Assess and gather context. Obtain vital signs, relevant history, medications, allergies, and the events leading to the illness. Check blood glucose when indicated and authorized. Look for medical identification, medication containers, and clues from the scene.

4. Reassess, transport, and report. Watch for changes and communicate important findings and symptom timelines. Do not delay transport of an unstable patient for a complete assessment.

Altered mental status should prompt consideration of several causes, including stroke, low blood glucose, hypoxia, infection, seizure, poisoning, and injury.

Recognize stroke and transient ischemic attack

Suspect stroke with sudden facial droop, one-sided weakness or numbness, abnormal speech, vision changes, loss of balance, or a severe unexplained headache. Use a validated stroke screen according to protocol. Record the patient's Last known well time—the last time they were at their usual baseline—not merely when they were found.

Check glucose if authorized, because low blood glucose can resemble stroke. Minimize delays and promptly notify the receiving facility. Symptoms that resolve may still indicate a transient ischemic attack requiring urgent evaluation.

Manage seizures safely

During a seizure, protect the patient from nearby hazards, cushion the head if possible, and time the event. Do not restrain the patient or put anything in the mouth.

After convulsions stop, assess breathing and injuries. Position the patient to help protect the airway when appropriate and monitor for postictal confusion. A prolonged or repeated seizure, first seizure, pregnancy, injury, or failure to regain normal responsiveness warrants urgent care. Do not give anything by mouth until the patient is fully alert and able to swallow safely.

Assess diabetes-related emergencies

Diabetes-related illness may result from hypoglycemia, meaning low blood glucose, or hyperglycemia, meaning high blood glucose. Hypoglycemia may cause sweating, shakiness, confusion, unusual behavior, weakness, or seizure. Prolonged hyperglycemia may be associated with thirst, frequent urination, dehydration, nausea, or altered mental status. Symptoms alone do not reliably distinguish the cause; check glucose when authorized and consider other explanations.

If the patient is awake and can swallow safely, assist with oral glucose only as permitted by protocol. Never give oral food, liquid, or glucose to a patient who is unconscious, seizing, or unable to swallow safely. Provide airway and supportive care, consider other causes of altered mental status, and arrange transport as indicated. Medication assistance, including glucagon, depends on EMT scope and local protocol.

Respond to respiratory emergencies

Asthma and chronic obstructive pulmonary disease (COPD) can cause wheezing, cough, chest tightness, and difficulty breathing. Assess speech, work of breathing, skin color, mental status, and respiratory effort. Worsening fatigue, poor air movement, cyanosis, or altered consciousness are danger signs.

Help the patient into a position that eases breathing, support oxygenation and ventilation as indicated, and assist with the patient's prescribed inhaler only as authorized. Severe or worsening symptoms require prompt transport. Wheezing is not the only sign of severe obstruction: very poor air movement may produce little audible wheezing.

Manage poisoning and toxic exposure

Consider poisoning or overdose when there is unexplained altered mental status, abnormal breathing, unusual pupils, a relevant scene, or multiple ill people. Do not enter a contaminated or potentially toxic atmosphere without appropriate training and protective equipment. Identify the substance, route, amount, and time of exposure if known, but do not delay life-saving care.

Support airway and breathing. Administer naloxone for suspected opioid overdose when authorized, while continuing to manage ventilation. Do not induce vomiting. For fumes, move the patient to fresh air only when it is safe. For skin or eye exposure, remove contaminated clothing and irrigate as appropriate to the substance and protocol. Contact Poison Control for expert guidance when appropriate; in the United States, the number is 1-800-222-1222.

Carbon monoxide (CO) is colorless and odorless. Headache, dizziness, weakness, nausea, chest discomfort, or confusion—especially in several people at the same location—may indicate exposure. Standard pulse oximetry can appear reassuring despite CO poisoning. Ensure scene safety, request appropriate fire or hazardous-materials resources, and remove patients from exposure only when responders can do so safely.

Respond to behavioral emergencies

Agitation or unusual behavior may result from a behavioral-health crisis, but it may also be caused by hypoxia, low blood glucose, head injury, intoxication, or another medical illness. Keep a safe distance, use a calm and respectful tone, reduce noise and unnecessary stimulation, and allow space and a clear exit.

Ask direct, nonjudgmental questions about immediate danger or self-harm when appropriate. Request additional trained resources if safety is uncertain. Avoid escalating confrontation or attempting physical restraint unless necessary to prevent immediate harm and permitted by policy. Treat medical threats, maintain observation, and follow local procedures for consent, capacity, and transport. A person in immediate danger or with a medical emergency needs an emergency response; behavioral crisis services may also be appropriate where available.

Identify and treat heat illness

Heat exhaustion may involve weakness, headache, nausea, heavy sweating, or dizziness. Confusion, seizure, collapse, or other altered mental status after heat exposure suggests life-threatening heat stroke.

Move the patient to a cooler area, remove excess clothing, and begin rapid cooling according to protocol while arranging emergency transport. Do not delay cooling while waiting for transport.

Respond to cold illness and frostbite

Hypothermia may cause shivering, poor coordination, confusion, slurred speech, and drowsiness. When severe, it may involve decreased shivering and slowed vital signs. Move the patient out of the cold, handle gently, remove wet clothing when feasible, and insulate with dry coverings. Avoid direct high heat, and do not give oral fluids to a patient who is not fully alert.

Frostbite commonly affects fingers, toes, ears, or the nose. Protect the affected area and do not rub or massage it.

Coordinate care and transport

Start with scene safety and immediate threats, then assess systematically, gather useful history, and reassess often. Recognize time-sensitive stroke, seizure, glucose, respiratory, toxicologic, behavioral, and environmental presentations. Provide only care authorized by EMT scope and local protocol, protect the airway, and arrange timely transport when the patient is unstable or the cause is uncertain.