Pre-hospital decisions.
Real consequences.
Branching clinical scenarios for paramedics and ambulance clinicians. Practise pre-hospital decision-making, see what changes, and build a clearer picture of your strengths across practice.
68-year-old with sudden dizziness
You attend a 68-year-old with sudden onset vertigo, vomiting and inability to stand. FAST is negative. What do you do next?
Track your progress
See performance across 7 clinical domains and identify areas to focus on.
Build CPD evidence
Download a named activity certificate after each completed scenario.
Realistic scenarios
Work through branching cases where plausible decisions produce different consequences.
Keep momentum
Build streaks and unlock achievements as your learning history grows.
Make every case count
A free account saves completed cases and scores, tracks your strengths across the 7 learning domains, unlocks achievements and lets you download named CPD activity certificates.
Welcome to On Scene
Sign in or create an account to save your scenario history and track your progress across devices.
Chest pain refusal
A hard case targeting material-risk discussion, use/weighing and a high-risk capacitous refusal.
Today’s scenario
A new scenario is selected automatically each day.
Your domain performance
Complete scenarios while signed in to build a picture of how you perform across different parts of pre-hospital decision-making.
What your recent attempts are showing
Library progressProgress by category11 categories
A scenario can contribute to more than one category when its learning overlaps.
Recent activityCompleted scenariosRecent 8
| Scenario | Category | Difficulty | Score |
|---|---|---|---|
| Sign in to load your saved attempts. | |||
ReflectionSaved reflections0 saved
Dynamic scenarios
The same case can unfold differently depending on your choices.
What do you do next?
Describe what you would actually do, in your own words. AI interprets the clinical intent of your response against the authored branches; you do not need to copy their wording. On Scene still controls the score, treatment record and what happens next.
Clinical decisions with consequences.
On Scene is a pre-hospital decision simulator. You are placed into an ambulance scenario, given the information available at that moment, and asked what you would do next. Your choices change what happens to the patient.
Dynamic branching
There is not always one linear route. A poor decision may delay care, worsen physiology, damage rapport or create a new problem you then have to recover from.
Difficulty means something
Easy cases reinforce core priorities. Moderate cases use competing but recognisable clinical options. Hard cases are assessment mode: several answers may be defensible, live scoring and evaluative feedback are withheld until the debrief, and the distinction may depend on current JRCALC detail, sequence, law, physiology or pathway knowledge. Checking current guidance is encouraged.
Not just right or wrong
Some choices are appropriate, some are reasonable but less optimal, and others are unsafe. Your route through the case is reflected in the debrief rather than simply stopping at the first mistake.
Built for reflection
Every completed case now ends with a structured debrief: key strengths, learning opportunities, treatment history and an optional personal reflection. Signed-in users can also build a persistent performance profile and receive targeted case recommendations.
Help keep On Scene free
On Scene is free to use and independently developed. If you have found it useful and would like to support ongoing development, hosting and new scenarios, you can buy us a coffee. There is absolutely no obligation.
Found something that doesn’t look right?
If you spot a clinical issue, technical problem or typo, please report it. Reports are reviewed to help improve future versions of On Scene.
Clinical decision-making practice, without putting the learning behind a paywall.
On Scene gives paramedic learners free access to realistic branching pre-hospital scenarios. Educator tools add the structure around that learning: cohorts, assignments, completion tracking and aggregate learning patterns.
Students and clinicians use the same On Scene case library without a paid individual tier. Organisations pay for educator functionality and learning administration rather than access to the clinical content itself.
Assign realistic cases
Create case sets from the On Scene library and give learners a clear set of scenarios to complete, with an optional due date.
Simple cohort management
Learners join with a cohort code using their existing On Scene account. There is no separate student platform to learn.
See learning patterns
Track assignment completion, review assigned-case attempts and view aggregate domain patterns to help identify themes worth revisiting in teaching or simulation.
Decision-making, not recall
Cases develop in response to the learner's choices, asking them to balance assessment, treatment, safety, communication and disposition.
Built around reflection
Learners receive a structured debrief and can save personal reflections and CPD evidence after completing a case.
Respectful analytics
Educator reporting is designed for learning. Educators can review scores and decision pathways for assigned-case attempts, while personal reflections and unassigned On Scene activity remain private.
What the cohort dashboard provides
The individual experience stays theirs
Start with a conversation, not a checkout page.
Educator access is provisioned by On Scene for participating universities and training organisations. If you would like to discuss a pilot, collaboration or organisational access, get in touch.
Join a cohort
Join a learning cohort using a code supplied by your educator.
Join a cohort
If your university, training provider or educator has given you a cohort code, sign in or create a free On Scene account to join and see your assigned cases.
What’s new
Recent changes to On Scene, and a look at some of the ideas planned for future development.
Recent updates
The six most recent changes to the simulator and learning experience.
What’s coming next
Ideas currently planned or being explored. The roadmap is intentionally flexible and may change as the site develops.
Contact us
General question, collaboration idea or something else you would like to discuss? Send a message here. For an error in a specific scenario, Report an issue is usually better because it can attach the case and decision route automatically.
Privacy
On Scene is an independent educational simulation tool. This page explains, in plain English, the information used when you visit the site or create an account.
What is collected
You can browse and complete scenarios without creating an account. If you create an account, On Scene may store your name, email address, optional profile image, completed scenario history, scores, domain scores, saved-case bookmarks, optional personal reflection notes, cohort memberships and assignments, achievements derived from that history and information needed to provide account features.
If you join a learning cohort, the educator managing that cohort can see your display name, assignment completion and the simulation score and decision pathway for attempts at cases assigned to that cohort. Educators cannot use the cohort dashboard to view your personal reflections or activity on cases that were not assigned through that cohort. Cohort-level learning patterns are also shown in aggregate.
AI free-text beta: In supported scenarios, decision text you submit is sent through a Supabase Edge Function to an external AI provider (OpenAI) so it can be interpreted against the authored scenario branches. Do not enter real patient-identifiable information. If you complete the case while signed in, your typed decision may be stored as part of your On Scene attempt record and, for a case assigned through a cohort, may be visible to the educator in the same way as the rest of that assigned attempt. Personal reflections remain separate.
If you submit a detailed issue report, the report may include the case, your route through it, the point in the case, the issue type and the text you provide. Your email address is included only when you choose that option. If you use Contact us, the name, email address, topic and message you submit are sent by email so the enquiry can be read and replied to. Quick useful/not-useful votes store the case, the vote and a random browser identifier used to reduce repeat voting.
Why the information is used
Information is used to provide saved progress, learning statistics, recommendations, CPD certificates, account features, troubleshooting and improvements to scenario quality. Quick feedback is used in aggregate to understand which cases are useful.
Services used
On Scene uses Supabase for account and application data and Edge Functions, Vercel for website hosting, and Resend for transactional email including account emails, detailed issue-report notifications and Contact us messages. If you choose the Ko-fi support button, Ko-fi opens as a third-party service and operates under its own privacy terms.
Browser storage
On Scene uses local browser storage for lightweight preferences and features such as dismissed prompts, notification state, pending completion data and a random feedback identifier. Clearing browser data may remove these local settings.
Your choices
You do not need an account to play scenarios. You can sign out at any time. If you have a question about information held by On Scene or want to request deletion of account data, use Contact us and choose Privacy / data request.
Clinical information
Do not enter identifiable patient information into feedback or contact forms. On Scene is not intended to receive or store real patient records.
Changes
This notice may be updated as On Scene develops. Material changes will be reflected on this page.
Terms of use
By using On Scene, you agree to use it as an educational and reflective learning resource rather than as a source of real-time clinical instruction.
Independent educational resource
On Scene is independently developed. It is not an official NHS, JRCALC, ambulance service, university or regulatory-body product, and use of the site does not imply endorsement by any of those organisations.
Not clinical guidance
Scenario content is designed for learning and reflection. It is not a substitute for current JRCALC guidance, local policies, medicines governance, professional judgement, senior clinical advice or appropriate escalation. Clinical guidance and local scope can change.
CPD certificates
A Certificate of CPD Activity records participation in an On Scene scenario. It does not certify competence, accreditation, mandatory training, qualification or clinical sign-off.
Your responsibility
You remain responsible for checking current guidance and acting within your own role, competence and local scope of practice. Do not use On Scene to make decisions about a real patient.
Accounts and acceptable use
You are responsible for keeping your account credentials secure. Do not attempt to interfere with the service, access another user’s information, automate abusive traffic or submit patient-identifiable information through feedback tools.
AI free-text beta
The AI free-text feature is an experimental interpretation layer. It does not generate the clinical score or decide how the patient should physiologically respond: it maps learner text onto an authored scenario branch, after which the normal On Scene case logic applies. AI interpretation can be imperfect. Where the system cannot confidently interpret a response, learners should clarify their wording or use the standard authored choices. The feature is educational and must not be used for real-patient clinical advice or documentation.
Cohorts and educator reporting
Cohort tools report participation, assignment completion, aggregate simulation learning patterns and, for cases assigned through the cohort, the learner's simulation score and decision pathway. Educator access is provisioned separately by On Scene for participating organisations and is not available through self-service signup. Personal reflections and unassigned On Scene activity are not exposed through the cohort dashboard. Cohort data are intended to support education and reflection and must not be treated as a clinical competency assessment, employment performance rating or professional sign-off.
Availability and accuracy
Reasonable efforts are made to keep the service and clinical content useful and current, but uninterrupted availability and error-free content cannot be guaranteed. Clinical or technical concerns can be reported through the site.
Content
On Scene scenarios and site content are provided for personal and professional learning. Bulk reproduction, republishing or presenting the material as an official clinical resource should not occur without permission.
Decision score and clinical safety are reported separately. A high percentage does not erase an unsafe action or a failed clinical outcome.
What will you take from this case?
Optional. Capture what went well, what surprised you or what you would do differently in practice.
One tap helps identify which scenarios are working well. No written feedback is required.