My brother was last seen at 3am and he woke his wife unable to speak and no movement. he was picked up by an emt with symptoms of new onset aphasia, they delivered him to the er at 9am. what would you do first?

This question has more details but it is difficult to understand the first sentence. Did your brother wake your wife up at 3 AM or was he last seen normal at 3 AM? Aphasia and no movement are consistent with a stroke but a focused neurologic exam is necessary and then brain imaging to rule out brain bleeding before deciding thrombolytic therapy upon history. Basically, my answer is the same.

Like Dr Le correctly interprets, this appears to have been a nocturnal presentation of a stroke, and the appropriate sequence in the ER involves history, physical exam, EKG, blood tests, brain imaging, consideration for possible TPA. Likely hospitalization will be subsequent, but many details need to be worked out.