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In addition to pupillary findings, any focal neurologic signs suggesting stroke or increased intracranial pressure should be noted. An unresponsive patient with focal neurologic signs or concern for elevated intracranial pressure (e.g., Cushing’s triad of hypertension, bradycardia, and irregular respirations) are especially concerning and may need rapid transport to a specialty center. Seizures or seizure‐like activity also cause altered mental status. Signs of ongoing seizure (fixed gaze, tonic‐clonic movements) or post‐ictal state (AMS with evidence of loss of bowel or bladder tone, tongue trauma) should be noted. Family or friends may be able to validate that the patient’s speech is not normal, providing evidence of altered content of consciousness. EMS personnel should screen for stroke using an established stroke scale, such as the Cincinnati Prehospital Stroke Scale, Los Angeles Prehospital Stroke Screen, or Melbourne Ambulance Stroke Screen [4–6]. To further guide patient care, assessment with a stroke screen that considers large vessel occlusion, such as the Rapid Arterial Occlusion Evaluation (RACE) scale for stroke, or the Stroke Vision, Aphasia, Neglect assessment, should be used in patients with signs of stroke to assist with transport destination decision‐making [7, 8].