Prehospital Neurological Examinations
Prehospital Neurological Examinations: Techniques for Paramedics and EMTsNeurological examinations are a vital component of clinical assessment in emergency and prehospital settings. They involve a systematic evaluation of neurological function through assessment of level of consciousness (using AVPU or Glasgow Coma Scale), pupillary response, limb strength, sensation, speech, coordination, and the presence of abnormal neurological signs such as seizures or posturing. These assessments help paramedics and prehospital clinicians detect stroke, traumatic brain injury, seizures, spinal cord injury, altered mental states, and other life-threatening neurological conditions.
In this series, we explore the fundamentals of neurological examination in the prehospital environment, including essential techniques, red flag indicators, and condition-specific considerations. Whether you’re assessing suspected stroke, head injury, seizure activity, or unexplained unconsciousness, this guide is designed to enhance your assessment skills and equip you to recognise and manage neurological emergencies with confidence and clinical accuracy.
Prehospital Neurological Examinations – Articles
Prehospital Neurological Examinations – Resources
🔗Neurological assessment with FAST to better detect posterior circulation stroke – Journal Of Paramedic Practice
This article by explores the limitations of the traditional FAST (Face, Arms, Speech, Time) tool in identifying posterior circulation strokes (PCS), which can present with atypical symptoms such as dizziness and visual disturbances. The author reviews evidence supporting the integration of additional neurological assessments alongside FAST to enhance prehospital detection of PCS, aiming to reduce misdiagnosis and improve patient outcomes
📥GCS Assessment Aid – glasgowcomascale.org
Download this quick-reference GCS Assessment Guide to support accurate and consistent Glasgow Coma Scale scoring. The guide provides a clear breakdown of eye, verbal, and motor response categories, with scoring criteria and prompts for each level. Ideal for paramedics, prehospital clinicians, emergency staff, and students, this tool helps reinforce reliable neurological assessments in both training and clinical settings.
📖 Coming Soon
Prehospital Neurological Examinations – Did You Know?
Altered level of consciousness is an early sign of neurological compromise
Changes in consciousness — detected using AVPU or the glasgow coma scale — may indicate serious conditions such as traumatic brain injury, stroke, hypoglycaemia, or toxicological causes.
Unequal pupils can suggest raised intracranial pressure or brain injury
Pupil size, symmetry, and reactivity are key indicators of potential intracranial pathology, especially following head trauma or suspected stroke.
Sudden speech difficulty may indicate an evolving stroke
Slurred speech, word-finding difficulty, or aphasia are critical signs of cerebral dysfunction and should prompt immediate stroke assessment.
Weakness or paralysis is a red flag for stroke or spinal injury
New onset unilateral weakness, paralysis, or sensory loss may signal a stroke or spinal cord injury and requires urgent recognition and management.
Seizure activity requires careful neurological assessment
Post-ictal confusion, prolonged seizure, or status epilepticus are medical emergencies that necessitate detailed prehospital neurological evaluation.
Prehospital Neurological Examinations – CPD Reflection Prompts
Reflective practice is a key part of continuing professional development (CPD) and clinical improvement. Use these prompts below to guide your self-reflection on a recent patient assessment.
Reflect on your recent neurological assessments in the field and consider the following prompts to guide your CPD entry:
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jWhat went well during your neurological examination?
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jWhat challenges did you encounter?
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jHow did your findings affect your clinical decision-making?
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jHow confident did you feel in interpreting neurological signs?
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jWhat would you do differently next time?
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Consider writing this reflection in your CPD portfolio or ePortfolio using the Gibbs Reflective Cycle or What? So What? Now What? framework. This reflective exercise not only enhances clinical self-awareness but also provides documented evidence of learning that can count towards your annual HCPC CPD requirements. Keeping detailed, structured reflections like this is essential for maintaining your registration and demonstrating safe, effective, and reflective practice as a healthcare professional. This can count toward your annual HCPC CPD requirements.
Prehospital Neurological Examinations – FAQs
Frequently Asked Questions about Prehospital Abdominal Examinations in Paramedic Practice
What is included in a prehospital neurological examination?
A prehospital neurological examination typically includes assessment of level of consciousness (AVPU, GCS), pupil size and reactivity, limb strength, sensation, coordination, speech, and the use of stroke assessment tools (such as FAST or BE-FAST).
How do paramedics assess level of consciousness?
Paramedics use simple tools such as the AVPU scale (Alert, Voice, Pain, Unresponsive) or the Glasgow Coma Scale (GCS), which provides a structured score based on eye opening, verbal response, and motor response.
When should a full neurological assessment be performed in the field?
A neurological assessment should be performed when the patient presents with altered mental status, suspected stroke, head injury, seizure, unexplained collapse, focal neurological deficits, or following any major trauma.
Why is early stroke recognition important in prehospital care?
Early recognition of stroke allows paramedics to pre-alert specialist stroke teams and optimise transport to an appropriate receiving centre. This improves access to time-critical treatments such as thrombolysis or thrombectomy, which are highly time-sensitive.
What is the role of GCS in head injury assessment?
The Glasgow Coma Scale helps paramedics quantify the severity of a head injury and monitor trends in consciousness. Changes in GCS can indicate deterioration and guide decisions about transport priority and need for advanced interventions.
