Scenario drills
All content is fictional and watermarked TRAINING SCENARIO. Never enter real PHI. Academy scoring only — for on-scene paste-out use HandoffNote.
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TRAINING SCENARIO
highChest Pain After Shoveling
chest pain · ~15 min
You are called to a residence for a 58 y/o man who developed sudden crushing chest pain at 09:10 while shoveling the front walk. He walked inside with his spouse and sat in a chair. He describes an elephant on his chest, 8/10, radiating to the left arm, with nausea. He has hypertension and a coronary stent three years ago. He is pale and diaphoretic. You give chewed aspirin and nitroglycerin; pain falls to 5/10 without hypotension. Transport ALS to a PCI-capable ED.
TRAINING SCENARIO
highCHF Dyspnea with Crackles
dyspnea · ~14 min
A 72 y/o woman with known CHF has had two hours of worsening shortness of breath and cannot lie flat. Her child reports a 3 lb weight gain over three days and missed last night's furosemide. She denies chest pain and fever. You find bilateral crackles and SpO2 88% on room air. CPAP at 5 cmH2O brings SpO2 to 94% and speech improves. One nitroglycerin SL is given with SBP remaining above 110. Transport upright to the ED.
TRAINING SCENARIO
mediumWitnessed Syncope
syncope · ~14 min
A 64 y/o man stood from a bus-stop bench, lost consciousness for about 30 seconds, and was caught by a bystander as he slumped. No seizure-like activity, no incontinence, no head strike. He woke confused for under a minute and is now dizzy but AOx3. Glucose is 92. He denies chest pain and palpitations now. You give oxygen as needed, monitor, and transport to the ED despite his preference to go home.
TRAINING SCENARIO
mediumElderly Ground-Level Fall
fall · ~15 min
An 81 y/o woman tripped on a throw rug at 11:30 and could not get up. She is on warfarin. She denies loss of consciousness, head strike, and chest pain. The right leg is shortened and externally rotated; PMS is intact. You pad and splint in position, consider spinal motion restriction (none applied — isolated hip, no midline spine pain, reliable exam), give fentanyl 50 mcg IV for 7/10 pain with relief to 4/10, and transport to the ED.
TRAINING SCENARIO
highMVC Restrained Driver
mvc · ~14 min
A 34 y/o restrained driver hits the rear of a stopped SUV at about 40 mph. Airbag deployed. He denies LOC and vomiting. He has midline cervical tenderness with intact PMS in all extremities. You apply a c-collar, package with a scoop/long board per protocol wording, give oxygen 15 L NRB for distress/tachypnea even though SpO2 is 98%, and transport to a trauma center. Extrication time is documented.
TRAINING SCENARIO
mediumHypoglycemia with Improvement
hypoglycemia · ~13 min
A 47 y/o woman with type 1 diabetes is found confused and sweaty after taking morning insulin and skipping breakfast. Fingerstick glucose is 48. She has not seized and denies chest pain. You give oral glucose gel; she swallows. Recheck is 96 and mentation clears. She agrees to ED evaluation for dose/meal mismatch.
TRAINING SCENARIO
mediumBehavioral — Objective Language
psych · ~13 min
PD requests EMS for a 29 y/o man pacing and speaking rapidly about being watched. No weapons are visible. He denies a plan to harm himself. Glucose is 102. He is AOx2 (not the date). You keep the environment calm, offer choices, and he agrees to voluntary transport. Document only what you see and hear — no pejorative labels.
TRAINING SCENARIO
lowLow-Acuity Refusal
refusal · ~13 min · refusal pack
A 26 y/o woman inverted her left ankle on a park path. Pain is 3/10. There is no deformity; PMS is intact. She is AOx4. You complete an assessment, offer ED transport, and explain the risk of occult fracture, delayed swelling, and inability to walk later. She refuses. Her friend witnesses. You advise RICE and 911 if worse, and complete a refusal pack.
TRAINING SCENARIO
highHigh-Risk Chest Pain Refusal
refusal · ~13 min · refusal pack
A 62 y/o man has 40 minutes of 6/10 substernal pressure with a history of hypertension. He is AOx4. You complete an assessment, offer ALS care and ED transport repeatedly, and explain the risks including myocardial infarction, arrhythmia, and death. He refuses. Spouse witnesses. He declines aspirin. Document the high-risk refusal pack in full.
TRAINING SCENARIO
highIFT Suspected Stroke
ift · ~13 min
You take a 71 y/o woman from a community ED to a comprehensive stroke center for thrombectomy evaluation. Last known well is 13:00. Sending NIHSS is 12 with facial droop, right arm drift, and mild aphasia. Glucose at sending was 118. tPA was not given (CTA showed proximal LVO; sending elected transfer). Maintain the IV, oxygen to keep SpO2 ≥94%, monitor, and document no seizure en route. Report to the accepting MD on arrival.
TRAINING SCENARIO
mediumPediatric Fever
peds · ~13 min
A 3 y/o, 14 kg, has had fever to 39.2°C since daycare called at noon. Mother is the historian. He has no rash and no respiratory distress. Wet diapers continue. Last acetaminophen 15 mg/kg at 12:30. You transport with the caregiver, monitor, and do not give additional antipyretic unless your training protocol says to document 'per protocol if applicable' — here you transport without a second dose because 4 hours have not elapsed.
TRAINING SCENARIO
mediumAsthma Exacerbation
dyspnea · ~14 min
A 22 y/o with known asthma has tight chest and wheeze after a cat entered her room. Her inhaler is empty. She denies chest pain and fever. SpO2 is 91% with expiratory wheezes. You give oxygen and albuterol nebulizer; SpO2 rises to 96% and wheezes decrease. Transport to the ED.
TRAINING SCENARIO
highAllergic Reaction
allergy · ~14 min
A 41 y/o man is stung on the left forearm at a picnic. Within 10 minutes he has hives, mild lip swelling, throat tightness, and SpO2 94%. He has never been intubated. No EpiPen was given before you. You give epinephrine IM, oxygen, and diphenhydramine if in your protocol (given here). Symptoms ease. ALS to the ED.
TRAINING SCENARIO
mediumPost-Ictal Patient
seizure · ~13 min
A 36 y/o man with known epilepsy has a witnessed generalized seizure about 1 minute long at work. No head trauma from the fall, no incontinence. He is post-ictal. Glucose is 108. You position the airway, give oxygen, and transport as he gradually awakens. He is not known pregnant (male). No midazolam given — seizure had stopped before arrival.
TRAINING SCENARIO
highSuspected GI Bleed
gi · ~13 min
A 78 y/o man has two days of melena and this morning nearly syncope on standing. He denies chest pain and has had no hematemesis today. He is pale, BP 88/54, HR 118. You give oxygen, monitor, a large-bore IV with fluids per ALS order, and emergent transport. He takes warfarin and ibuprofen.
TRAINING SCENARIO
highSuspected Opioid Overdose
overdose · ~14 min
A 27 y/o is found unresponsive with RR 4, pinpoint pupils, SpO2 78%, no trauma. Friend reports possible opioid use. You BVM and give naloxone. RR rises to 14 and he withdraws to pain. Transport. Stay objective — no slang labels.
TRAINING SCENARIO
highField Stroke Alert
stroke · ~14 min
A 68 y/o woman was last known well at 07:45. At 07:55 her spouse saw facial droop, arm drift, and slurred speech. Glucose is 118. No seizure. You call a stroke alert and rapidly transport to a stroke center on oxygen as needed.
TRAINING SCENARIO
mediumPartial Thickness Burn
burn · ~14 min
A 45 y/o woman scalds her left forearm with boiling water. Pain is 7/10. Blisters over an estimated 3% TBSA (training estimate only). Airway is clear; no inhalation. You cool briefly per protocol, dress, give fentanyl 50 mcg IN for pain to 4/10, and transport to a burn-capable ED.
TRAINING SCENARIO
mediumPregnancy Cramping
ob · ~13 min
A 28 y/o G2P1 at 32 weeks has intermittent cramping every ~8 minutes. She denies vaginal bleeding and you see no crowning. Fetal movement is present per patient. You place her left lateral, give oxygen, and transport to an OB-capable ED. Keep language objective and respectful.
TRAINING SCENARIO
mediumHeat Exhaustion
environmental · ~13 min
A 38 y/o construction worker becomes dizzy after four hours in 94°F heat. He did not seize and denies chest pain. He is diaphoretic, HR 120, temp 38.4°C. You move him to shade, begin cooling, give oxygen, and offer oral fluids as he is alert. Transport to the ED.
TRAINING SCENARIO
highPediatric Guardian Refusal
refusal · ~12 min · refusal pack
A 2 y/o, 12 kg, is febrile to 38.8°C but currently alert without respiratory distress. Father is the on-scene guardian. You assess, offer ED transport, and explain risks of serious bacterial infection, dehydration, and delayed care. He refuses. Mother on the phone agrees with refusal. Witness is a neighbor who came over. Document guardian refusal carefully. Child has no distress currently.
TRAINING SCENARIO
mediumAcute Abdominal Pain
abdominal · ~13 min
A 24 y/o woman has RLQ pain that migrated from the periumbilical area over 6 hours, now 7/10, worse with movement. She denies vomiting blood and is not pregnant by home test this morning (still document 'no pregnancy known' / patient reports negative home test). Exam: tender RLQ with rebound. Position of comfort, no oral intake, transport.
TRAINING SCENARIO
highRestaurant Anaphylaxis
allergy · ~14 min
A 33 y/o with known peanut allergy develops hives, throat tightness, and dyspnea minutes after a sauce at a restaurant. She has not given epinephrine yet today. SpO2 92%, HR 120, scattered wheeze, urticaria. You give epinephrine 0.3 mg IM immediately, oxygen, a second epi at 19:23 for lingering dyspnea, and ALS transport. She improves but is not cleared on scene.
TRAINING SCENARIO
mediumFirst-Time Seizure
neuro · ~13 min
A 19 y/o has a first-time witnessed generalized seizure ~90 seconds in a store. No head trauma reported. She is postictal. Glucose is 94. You support the airway, check glucose, give oxygen, and transport. She is not known pregnant; she later says LMP two weeks ago.
TRAINING SCENARIO
mediumHypoglycemia at Work
medical · ~14 min
A 31 y/o with type 1 diabetes is found sweaty and confused at her desk after taking insulin and skipping lunch. Glucose 42. She denies chest pain. You give oral glucose; she swallows. Recheck 101, mentation clears. She wants to stay at work; this scenario outcome is still transport for evaluation after a workplace event.
TRAINING SCENARIO
highSuspected Opioid OD
tox · ~14 min
PD finds a 44 y/o unresponsive in a restroom with pinpoint pupils, RR 5, SpO2 80%, no trauma apparent. You BVM and give naloxone IM then IN. Breathing improves. He remains groggy. Transport. Objective language only.
TRAINING SCENARIO
highMorning Stroke Alert
neuro · ~14 min
A 70 y/o man is last known well at 06:30. At 06:38 his spouse finds right facial droop and right arm weakness. Glucose 126. Cincinnati/stroke scale positive. You notify the destination and transport rapidly to a stroke center.
TRAINING SCENARIO
highImminent Delivery
ob · ~14 min
A 31 y/o at 39 weeks is crowning on the bathroom floor. She denies heavy bleeding initially. You deliver on scene with the OB kit, dry-warm-stimulate the newborn, start maternal fundal care, and transport mother and newborn to an OB ED. Newborn cries within 20 seconds. Document times of crowning, delivery, and first cry.
TRAINING SCENARIO
mediumKitchen Scald Burn
trauma · ~13 min
A 52 y/o man spills a pot of boiling pasta water onto both anterior thighs. Airway clear; he denies inhalation injury symptoms (no cough, no soot, no voice change). Blisters, estimated 8% TBSA training only. You cool briefly, stop cooling, apply a dry sheet, give pain medication, and transport.
TRAINING SCENARIO
lowVoluntary Psych Transport
psych · ~12 min
A 23 y/o requests voluntary transport for depression. She denies a current SI plan. Glucose 94. Exam otherwise unremarkable. You use verbal de-escalation (calm, choices), complete medical rule-outs, and transport voluntary without restraints. Objective language only.
TRAINING SCENARIO
mediumImproved Hypoglycemia Refusal
refusal · ~12 min · refusal pack
A 55 y/o with type 2 diabetes is found confused; glucose 46. Oral glucose given; recheck 108; mentation AOx4. He refuses transport. Capacity is intact. You explain risks of recurrent hypoglycemia, seizure, and death, offer ED, give return precautions, and complete a refusal pack with the spouse as witness.
TRAINING SCENARIO
mediumHeat Exhaustion Sideline
environmental · ~14 min
A 17 y/o football player develops weakness and heat cramps after sprints. The athletic trainer has already started cooling. He is AOx4, diaphoretic, HR 118, temp 38.6°C. He denies syncope after cooling. You continue shade, ice towels, oral fluids as he is alert, and transport. Parent arrives as you load and rides along.
TRAINING SCENARIO
highCOPD Exacerbation
dyspnea · ~14 min
A 68 y/o man with COPD has three days of thicker yellow sputum and tonight cannot get air out. Home oxygen at 2 L is not helping. He denies chest pain and fever. You find diffuse wheeze and SpO2 86% on room air. Nebulized albuterol and oxygen to his home 2 L baseline bring SpO2 to 92% and speech improves. Transport upright to the ED.
TRAINING SCENARIO
highEpigastric ACS in a Woman
chest pain · ~16 min
A 62 y/o woman with type 2 diabetes develops epigastric pressure at 11:20 while walking the dog. She calls it indigestion and denies crushing chest pain and syncope. She is pale and diaphoretic. You give chewed aspirin and nitroglycerin; pain falls from 7/10 to 4/10 without hypotension. A 12-lead is obtained and transmitted without a field diagnosis written. Transport ALS to a PCI-capable ED.
TRAINING SCENARIO
highWitnessed Arrest with ROSC
cardiac · ~15 min
A 55 y/o man told his spouse his chest hurt at 07:02, then collapsed. Spouse started CPR immediately. There was no bystander AED before the engine. Engine AED delivered one shock at 07:08. ROSC at 07:11 with a pulse and gasping. Post-ROSC BP 92/58, GCS 3 then 8. You continue airway support, obtain and transmit a 12-lead without writing an interpretation, and transport ALS to a PCI-capable ED with timed handoff.
TRAINING SCENARIO
highNursing Home Sepsis
medical · ~14 min
An 81 y/o nursing-home resident is not at baseline. Staff report two days of dysuria and cloudy urine. She is hypotensive at 88/54, HR 118, temp 38.9°C, SpO2 91% RA, GCS 13. There is no trauma. Staff deny chest pain statements. You give oxygen and a 500 mL NS bolus; BP rises to 96/58. Sepsis alert to the ED and ALS transport.
TRAINING SCENARIO
highNew-Onset DKA
medical · ~13 min
A 16 y/o has four days of thirst, urination, and weight loss, now sleepy with deep Kussmaul respirations. He denies chest pain and fever. Glucose reads HI/high on the meter. You support ABCs, give oxygen as tolerated, do not give insulin in this scenario, and transport ALS with the parent to the ED for suspected new-onset DKA.
TRAINING SCENARIO
highMotorcycle vs Car
trauma · ~15 min
A 24 y/o helmeted motorcyclist hits a car turning left at about 25 mph. He reports no loss of consciousness and has no stridor. The left mid-femur is angulated with distal PMS present. You apply a c-collar, traction splint, give fentanyl, and transport to the trauma center. Document mechanism, PMS checks, and packaging.
TRAINING SCENARIO
mediumElderly Hip Fracture
fall · ~14 min
An 84 y/o woman trips on a rug at 09:50 and cannot get up. She had no loss of consciousness and denies chest pain or a head strike. The left leg is shortened and externally rotated with distal PMS present. You give fentanyl 25 mcg IV, package on a scoop stretcher, and transport to the ED. Do not claim a confirmed fracture — document the classic exam.
TRAINING SCENARIO
mediumPediatric Croup
peds · ~13 min
A 2 y/o, 12 kg, wakes with a barky cough and mild inspiratory stridor. Parent denies a foreign body and there is no drooling. SpO2 is 97% on room air. Cool night air to the ambulance quiets the stridor. You keep her in a position of comfort with the caregiver and transport to the peds ED. Blow-by oxygen is available but unused.
TRAINING SCENARIO
mediumPediatric Febrile Seizure
peds · ~14 min
An 18-month, 11 kg, has a first-time generalized seizure lasting about two minutes during a febrile URI. She is postictal on arrival then returns to clinging alertness. Temperature 39.4°C, glucose 98. No neck stiffness, no prior seizure history. Acetaminophen was given at 18:30. Recovery position until alert, then peds ED with the parent. No benzodiazepine — the seizure had stopped.
TRAINING SCENARIO
highPostpartum Hemorrhage
ob · ~15 min
A 28 y/o had an uncomplicated vaginal delivery at a birth center at 03:10. Two hours later pads are soaked and the fundus is boggy. She denies headache and has had no seizure. Newborn is vigorous with the midwife. You continue fundal massage, give high-flow oxygen, keep her warm, start a large-bore IV, and transport rapidly to an OB ED. Fundus firms and BP rises from 92/58 to 100/62.
TRAINING SCENARIO
highSuspected Pulmonary Embolism
dyspnea · ~13 min
A 41 y/o woman develops sudden pleuritic dyspnea at 12:40, one day after a transcontinental flight. She denies fever and crushing chest pain. SpO2 is 90% on room air with a clear lung exam and a larger right calf. Oxygen by NRB brings SpO2 to 96%. You transport rapidly ALS for suspected pulmonary embolism. No field anticoagulants in this scenario.
TRAINING SCENARIO
highHousehold Carbon Monoxide
environmental · ~13 min
A 34 y/o is evacuated when the apartment carbon monoxide detector alarms. She has a pounding headache and nausea since waking. She denies syncope and has no burn injury. SpO2 is 98% on room air — document that pulse oximetry is not reliable for carbon monoxide. You keep her out of the environment, give high-flow oxygen by NRB, and transport to an ED with CO evaluation capability. Other occupants go with another unit.