Medical Patient Assessment for EMTs: the NREMT skill sheet, step by step
By Rounds EMS
Updated September 28, 2026 · 11 min read
Always follow your local protocols. Oxygen targets, treatments and how your skills exam is run vary by state, program and medical director. This guide prepares you for the NREMT exam and your skills testing; your protocols decide what you do on a call.
Scene size-up, primary survey, history, secondary assessment, vital signs, reassessment. The NREMT’s EMT skill sheet “Patient Assessment/Management – Medical” grades you on those blocks in that order, and it fails you outright for a short list of misses, like not calling for transport within 15 minutes. Below is the sheet’s sequence in plain words, with OPQRST and SAMPLE as charts you can drill. Get the official sheet itself from the National Registry (linked in Sources).
The whole sheet in 13 steps
This is the order printed on the NREMT’s EMT medical sheet (form E202). The NREMT says each state sets and approves its own EMT skills exam, so your program may use this sheet or a close copy.
- PPEPut on or say out loud the protection the call needs, before you touch anyone.
- Scene size-upScene safe, nature of illness, number of patients, more help if needed, and whether the spine needs stabilizing.
- General impressionSay what you see from the doorway: how sick this patient looks.
- ResponsivenessLevel of consciousness using AVPU.
- Chief complaint and life threatsWhy they called, and anything that could kill them in the next few minutes.
- Airway and breathingAssess, make sure ventilation is adequate, start the right oxygen.
- CirculationMajor bleeding, pulse, and skin color, temperature or condition.
- Priority and transport decisionGo now, or stay and keep assessing.
- History of the present illnessOPQRST, plus follow-up questions about related symptoms.
- Past medical historyThe rest of SAMPLE.
- Secondary assessmentExamine the body system the complaint points to.
- Vital signs, field impression, interventionsBlood pressure, pulse, respiratory rate and quality. Then say what you think is wrong and how you will treat it.
- Reassessment and handoffShow how and when you recheck, then give an accurate verbal report to the arriving EMS unit.
Scene size-up
Before you touch the patient
- PPE first
- Match it to the exposure you expect: gloves, plus a mask, eye protection or gown when blood, body fluids or an airborne illness are likely. Missing PPE is a critical failure on its own.
- Scene safe
- Look for traffic, fire, gas, chemicals, weapons or an agitated person before you walk up. If you cannot make it safe, stay back and call for the people who can.
- Nature of illness
- Read dispatch, the room and the people in it. Pill bottles or an oxygen concentrator talk before the patient does.
- Patients and help
- Count patients. Ask for more ambulances, fire or police early, not after you are overwhelmed.
- The spine
- The medical sheet still lists it. A patient who fainted and fell can have a neck injury on top of the medical problem.
Exam trap: scene safety has to come before you approach the patient. Stating it after you have started your assessment is one of the listed critical fails.
Primary survey: find what kills first
Find the life threats first
- General impression
- Stable, potentially unstable, or unstable. Say it out loud: “Adult female sitting upright, working hard to breathe, pale.”
- AVPU
- Alert, responds to Verbal, responds to Pain, or Unresponsive. Introduce yourself as you do it.
- Chief complaint
- One open question: “What made you call 911 today?” Then look for anything life-threatening.
- Airway
- Talking means the airway is open for now. Unresponsive medical patient: head-tilt, chin-lift. Suction liquids, remove solid objects, and listen for stridor, a high-pitched sound of a narrowing airway.
- Breathing
- Rate and quality. EMT training flags faster than 24 or slower than 8 breaths a minute in an adult. If breathing is inadequate, ventilate with a bag-valve mask. If it is adequate, give oxygen per protocol (the national model guideline targets 94–98% saturation).
- Circulation
- Stop major bleeding, check the pulse, then skin: color, temperature and moisture.
- Transport call
- Unstable: load and go, finish the history on the way. Stable: stay and continue the assessment on scene.
Exam trap: oxygen alone is not the fix for a patient who is barely breathing. The sheet lists “assures adequate ventilation” separately from “initiates appropriate oxygen therapy”, and failing either one is a critical fail.
History of the present illness: OPQRST
OPQRST takes the chief complaint apart. The sheet grades all six letters plus follow-up questions about related symptoms, so chest pain also gets asked about nausea, sweating and shortness of breath.
| Letter | What you are finding out | Ask it like this |
|---|---|---|
| O · Onset | When it started and what they were doing, sudden or gradual | “What were you doing when this started?” |
| P · Provocation | What makes it worse, what makes it better, which position is easiest | “Does anything make it better or worse, like moving or breathing deep?” |
| Q · Quality | Their own words for it: sharp, dull, crushing, burning, pressure | “Can you describe what it feels like?” |
| R · Radiation | Where exactly it is and whether it spreads | “Point with one finger where it hurts most. Does it move anywhere?” |
| S · Severity | A number on a pain scale, now and at the start | “From 1 to 10, with 10 the worst you can imagine, where is it now?” |
| T · Time | How long it has lasted, and whether it is constant or comes and goes | “How long has this been going on? Has it been constant?” |
Exam trap: OPQRST is built for pain but works for any complaint. For shortness of breath or dizziness, ask the same six questions about that symptom.
Past medical history: SAMPLE
The sheet grades A, M, P, L and E here; the S is what OPQRST already gathered. If the patient cannot answer, get it from family, bystanders, pill bottles and medical ID jewelry.
| Letter | What you are finding out | Ask it like this |
|---|---|---|
| S · Signs and symptoms | What you can see or measure, and what they feel | “Are you feeling anything else, like nausea or dizziness?” |
| A · Allergies | Medication, food and environmental allergies | “Are you allergic to any medicines, foods or anything else?” |
| M · Medications | Prescriptions, over-the-counter, vitamins and herbals, birth control, erectile dysfunction drugs, someone else’s pills, recreational drugs | “What medicines do you take, including ones without a prescription? Did you take them today?” |
| P · Past history | Conditions, surgeries and hospital stays that relate to this problem; possible pregnancy | “Do you have any medical problems, like heart trouble, diabetes or asthma?” |
| L · Last oral intake | Last food, drink or other substance, and when | “When did you last eat or drink, and what was it?” |
| E · Events | What happened just before this started | “Walk me through what happened right before you felt this.” |
Exam trap: the M question has to catch an erectile dysfunction drug. It decides whether nitroglycerin is safe, which is covered in the EMT medications guide.
Secondary assessment: examine the system the complaint points to
For a medical patient the exam is focused. The sheet names eight body systems; assess the ones the complaint points to. Starting this exam before you have handled airway, breathing and circulation is a critical fail. For a head-to-toe on an injured patient, see the trauma assessment guide.
| System | Complaints that point here | What to check |
|---|---|---|
| Pulmonary | Shortness of breath, cough, wheezing | Chest rise and symmetry, accessory muscles, retractions, breath sounds on both sides |
| Cardiovascular | Chest pain, palpitations, fainting | Pulse rate, rhythm and strength, neck vein swelling, swelling in the legs |
| Neurological | Confusion, weakness, seizure, headache | AVPU and orientation, speech, facial symmetry, pupils, movement and feeling in all four limbs |
| Musculoskeletal | Back pain, limb pain, a fall | Symmetry, tenderness, range of motion, pulses and sensation past the painful area |
| Integumentary | Hives, pale or flushed skin, sweating | Skin color, temperature and moisture |
| GI/GU | Abdominal pain, vomiting, urinary problems | Tenderness, rigidity, swelling of the abdomen, scars and medical devices |
| Reproductive | Lower abdominal pain, vaginal bleeding | Possible or recent pregnancy, and any bleeding |
| Psychological/Social | Behavior change, depression, a crisis | Mood, thoughts of suicide, logical thinking, hearing or seeing things that are not there |
Vital signs, field impression, interventions
Look where the complaint points
- Vital signs
- The sheet lists blood pressure, pulse, and respiratory rate and quality. Add pupils, SpO2 and blood glucose per protocol.
- Baseline
- This first set is your baseline. The national model guideline asks for at least two sets on a stable patient, ideally one shortly before you reach the hospital.
- Field impression
- One line on what you think is wrong: “possible low blood sugar.” It picks your treatment path.
- Interventions
- Say the treatment that fits the impression: positioning, oxygen, a medication you can give or assist with per protocol, and transport. Ordering something dangerous or wrong for this patient is a critical fail.
Reassessment and handoff
- How often
- An unstable patient every 5 minutes. A stable patient at least every 15 minutes. That is the national EMT curriculum’s interval. The sheet has a line for showing how and when you reassess, so say the interval out loud.
- What you recheck
- The primary survey (mental status, airway, breathing, circulation), vital signs, the chief complaint, and whether each treatment worked.
- Ask again
- “Is the pain the same, better or worse? Anything new?” A new complaint sends you back to the primary survey.
- Verbal report
- The sheet ends with an accurate verbal report to the arriving EMS unit. A good report covers the patient’s age, chief complaint, history of the present illness, past history, medications, allergies, timed vital signs, what you did and how the patient responded.
Mistakes that fail the station
These are the critical criteria printed on the EMT medical sheet. Any one of them fails the station, whatever else you scored.
- No transport in 15 minutes. You did not start or call for transport within the 15-minute limit.
- No PPE. You did not put on or state the right precautions.
- No scene safety check before you approached the patient.
- Oxygen missed. You did not state, and then provide, appropriate oxygen therapy.
- Ventilation missed. You did not assess or provide adequate ventilation.
- ABC problems missed. You did not find or properly manage a problem with airway, breathing, bleeding or shock.
- Wrong transport decision. You could not tell whether the patient needed to go now or could stay for more assessment and treatment.
- Secondary before primary. You started the secondary exam before handling threats to airway, breathing and circulation.
- Dangerous intervention. You used or ordered a dangerous or inappropriate treatment.
- Bad handoff. You did not give an accurate report to the arriving EMS unit.
- Not a competent EMT. You did not manage the patient as a competent EMT would.
- Unacceptable affect toward the patient or other personnel.
A real medical assessment question
While obtaining a SAMPLE history, the patient suddenly says, “My heart feels like it’s racing.” The patient is alert and anxious, has a rapid, regular radial pulse, a blood pressure of 124/78 mm Hg, and warm, dry skin. What is the MOST appropriate EMT action?
- Obtain a complete set of vital signs before repeating the primary assessment.
- Determine whether the patient has experienced similar episodes before reassessing circulation.
- Reassess airway, breathing, circulation, and perfusion for signs of instability.
- Complete the SAMPLE history before reassessing the pulse and blood pressure.
Show the answer
C. Reassess airway, breathing, circulation, and perfusion. The clue is a new symptom appearing in the middle of your assessment. A change in the patient sends you back to the primary survey first, to see whether they are still stable. Confusion, low blood pressure, weak pulses, chest discomfort or poor breathing would raise your concern.
A sounds careful, but a full set of numbers is slower than a quick look at mental status, breathing, pulse quality and skin, and it does not replace that look. B asks about past episodes, which says nothing about how the patient is handling this one. D finishes the history first and could hide a patient who is getting worse.
Something new happens, so the history waits while you recheck the ABCs.
Frequently asked questions
What is the difference between OPQRST and SAMPLE?
OPQRST digs into the complaint happening right now: when it started, what changes it, what it feels like, where it goes, how bad it is and how long it has lasted. SAMPLE covers the patient behind the complaint: symptoms, allergies, medications, past history, last oral intake and the events that led up to the call.
How long do you get for the medical assessment skill?
The NREMT EMT medical sheet makes it a critical failure if you have not started or called for transport within 15 minutes. The NREMT says each state sets and approves its own EMT skills exam process, so confirm the details with your program.
Do I do a full head-to-toe exam on a medical patient?
Usually not. The national EMT curriculum says a complete secondary exam may not be appropriate for every medical patient, and the medical sheet credits a focused exam of the body systems the complaint points to, such as the lungs for shortness of breath.
How often should an EMT reassess a medical patient?
Every 5 minutes for an unstable patient and at least every 15 minutes for a stable one, per the national EMT curriculum and your protocol. Also recheck the patient whenever they report something new, and after each treatment to see whether it worked.
Sources
Steps, critical criteria and clinical thresholds on this page were checked against these documents. Question counts come from the Rounds EMS question bank as of September 27, 2026.
- EMT Psychomotor Examination: Patient Assessment/Management – Medical (form E202). National Registry of Emergency Medical Technicians, 2016.
- EMR and EMT Certification Examinations. National Registry of Emergency Medical Technicians, 2025.
- National EMS Education Standards: Emergency Medical Technician Instructional Guidelines. NHTSA, 2009.
- National Model EMS Clinical Guidelines, Version 3.0. NASEMSO, 2022.
Please follow your local protocols and your medical director’s orders. This guide is for exam study only and does not replace them.