Cognitive Biases and Errors Practice Questions

61 multiple-choice questions on Cognitive biases and errors for paramedic and EMT students, from Chapter 12 (Critical Thinking and Clinical Decision Making). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

61 practice questions

1. Anchoring bias occurs when a provider:

   1. A. Changes the impression too often
   2. B. Consults medical control too readily
   3. C. Fails to adjust an early impression
   4. D. Relies on a structured checklist
   Show answer

   Answer: C. Fails to adjust an early impression

   The dispatch complaint is a common anchor.

2. Confirmation bias occurs when a provider:

   1. A. Favors findings that fit and discounts the rest
   2. B. Repeats assessments to confirm the findings
   3. C. Asks open-ended questions to avoid leading
   4. D. Actively seeks evidence against the impression
   Show answer

   Answer: A. Favors findings that fit and discounts the rest

   Deliberately asking what does not fit counteracts it.

3. Premature closure means:

   1. A. Closing the patient care report too quickly
   2. B. Settling on an answer too early
   3. C. Ending the transport earlier than planned
   4. D. Ending the patient interview politely
   Show answer

   Answer: B. Settling on an answer too early

   It is one of the most common causes of diagnostic error. It means settling before adequately considering alternatives.

4. Availability bias occurs when a provider:

   1. A. Overrates diagnoses that come easily to mind
   2. B. Gathers more data than the case requires
   3. C. Reviews the protocols before every decision
   4. D. Uses whatever equipment is available
   Show answer

   Answer: A. Overrates diagnoses that come easily to mind

   A memorable recent call skews judgment for weeks.

5. Tunnel vision in patient care refers to:

   1. A. Reluctance to commit to any impression
   2. B. Protocols that limit treatment choices
   3. C. Fixing on one problem and missing others
   4. D. Switching focus too often between problems
   Show answer

   Answer: C. Fixing on one problem and missing others

   A dramatic injury often distracts from a quieter, deadlier one. Reluctance to commit and constant switching between problems are the opposite of tunnel vision, which narrows attention onto one problem.

6. Search satisficing describes:

   1. A. Searching thoroughly before concluding
   2. B. Stopping the search after the first finding
   3. C. Using a checklist to guide the exam
   4. D. Accepting a patient's refusal of care
   Show answer

   Answer: B. Stopping the search after the first finding

   After finding one fracture, keep looking for the second.

7. Framing bias occurs when:

   1. A. Findings are documented in a set format
   2. B. Vital signs are trended rather than read once
   3. C. How information is presented skews conclusions
   4. D. Protocols are followed in a fixed order
   Show answer

   Answer: C. How information is presented skews conclusions

   Start your own assessment fresh. For example, dispatch describing a frequent caller shapes conclusions before assessment.

8. Attribution bias occurs when a provider:

   1. A. Follows the group's view without checking it first
   2. B. Favors the diagnosis seen most recently
   3. C. Blames symptoms on the patient's character
   4. D. Holds onto the first impression formed
   Show answer

   Answer: C. Blames symptoms on the patient's character

   Patients who are intoxicated or homeless still have strokes and bleeds. For example, assuming intoxication. Following the group without checking is the bandwagon effect, favoring the most recent diagnosis is availability bias, and holding onto the first impression is anchoring.

9. Overconfidence contributes to error because it:

   1. A. Reduces the perceived need to reconsider
   2. B. Leads to excessive testing before acting
   3. C. Causes the provider to second-guess plans
   4. D. Improves the speed of decisions
   Show answer

   Answer: A. Reduces the perceived need to reconsider

   Experience reduces error only when paired with humility. Excessive testing and constant second-guessing reflect too little confidence, not too much; overconfidence makes reconsidering feel unnecessary.

10. Fatigue affects clinical reasoning by:

    1. A. Mainly slowing motor skills, not thinking
    2. B. Causing overly broad differentials
    3. C. Increasing reliance on mental shortcuts
    4. D. Improving pattern recognition speed
    Show answer

    Answer: C. Increasing reliance on mental shortcuts

    Errors rise sharply late in long shifts. It also slows processing and narrows attention. Fatigue affects judgment as well as motor skills, and it narrows rather than broadens the differential as tired providers lean on shortcuts.

11. A frequent caller with familiar complaints should be:

    1. A. Transported without a full assessment
    2. B. Documented as a routine, nonurgent call
    3. C. Assessed as carefully as any other patient
    4. D. Assessed more quickly than other patients
    Show answer

    Answer: C. Assessed as carefully as any other patient

    The trap is assuming this call is like the last one.

12. Which technique best counteracts cognitive bias in the field?

    1. A. Asking what else this could be
    2. B. Following dispatch information closely
    3. C. Working faster to limit scene time
    4. D. Relying on your first impressions
    Show answer

    Answer: A. Asking what else this could be

    A brief structured pause changes decisions. Also ask what the worst possibility is.

13. Diagnostic momentum occurs when:

    1. A. A differential diagnosis is built
    2. B. An earlier label goes unquestioned
    3. C. Protocols are followed step by step
    4. D. A patient improves after initial treatment
    Show answer

    Answer: B. An earlier label goes unquestioned

    Verify the label against your own findings. The label may come from dispatch or a previous provider.

14. The best general defense against error is:

    1. A. Confidence in your impressions
    2. B. A consistent, systematic assessment
    3. C. Speed in reaching decisions
    4. D. Years of field experience alone
    Show answer

    Answer: B. A consistent, systematic assessment

    Systems catch what attention misses.

15. The 12-lead computer reads 'normal ECG,' so a paramedic does not read the tracing himself. It shows subtle ST elevation. Which bias is this?

    1. A. Hindsight bias
    2. B. Commission bias
    3. C. Automation bias
    4. D. Sunk cost bias
    Show answer

    Answer: C. Automation bias

    Automation bias is over-trusting a device's output. Computer ECG interpretation misses subtle STEMIs, so read every tracing yourself. Hindsight bias is judging past decisions by their outcome, commission bias is acting when you should not, and sunk cost bias is continuing a plan because of effort already spent.

16. Which question best shows the debiasing strategy of 'considering the opposite'?

    1. A. 'How quickly can we finish the asthma protocol?'
    2. B. 'Which wheezing findings confirm my asthma call?'
    3. C. 'What findings would prove this isn't asthma?'
    4. D. 'Did the last asthma patient respond to albuterol?'
    Show answer

    Answer: C. 'What findings would prove this isn't asthma?'

    Considering the opposite means deliberately looking for evidence against your impression, which counters confirmation bias and premature closure. Looking only for confirming findings is confirmation bias, racing through a protocol skips the check, and the last patient's response says nothing about this one.

17. A 30-year-old with vomiting is thought to have 'stomach flu.' Which finding should make you abandon that impression?

    1. A. Two loose stools in the past day
    2. B. Mild cramping before each stool
    3. C. Fruity breath and deep, rapid breathing
    4. D. A child at home who has also been vomiting
    Show answer

    Answer: C. Fruity breath and deep, rapid breathing

    Kussmaul respirations with fruity (ketotic) breath suggest diabetic ketoacidosis, which can first present as 'stomach flu,' so check the glucose. Loose stools, cramping, and a sick contact all support gastroenteritis.

18. After reading about pheochromocytoma, a paramedic suspects it in every hypertensive patient. Which error is this?

    1. A. Gambler's fallacy
    2. B. Hindsight bias
    3. C. Base-rate neglect
    4. D. Omission bias
    Show answer

    Answer: C. Base-rate neglect

    Base-rate neglect means ignoring how common a condition actually is. Pheochromocytoma is rare, and essential hypertension, pain, anxiety, and nonadherence are far more likely causes. The gambler's fallacy is believing that past independent events change the next probability, hindsight bias judges past decisions by their outcome, and omission bias favors not acting.

19. A paramedic assumes a frequent-flyer intoxicated patient is 'just drunk again' and misses a head injury. This illustrates:

    1. A. Sound pattern recognition of a known patient
    2. B. Labeling bias leading to premature closure
    3. C. Omission bias from fear of overtreatment
    4. D. Availability bias from a recently memorable case
    Show answer

    Answer: B. Labeling bias leading to premature closure

    Labeling patients based on past behavior or stereotypes causes missed diagnoses. This is attribution/labeling bias, which then produces premature closure.

20. Everyone on scene agrees a patient is 'just anxious' because the senior captain said so, and no one checks the glucose. Which bias is this?

    1. A. Bandwagon effect
    2. B. Hindsight bias
    3. C. Omission bias
    4. D. Base-rate neglect
    Show answer

    Answer: A. Bandwagon effect

    The bandwagon effect (groupthink) is accepting a conclusion because others hold it, especially a senior person. Each provider should still assess independently, and a glucose check is cheap. Hindsight bias, omission bias, and base-rate neglect describe other errors.

21. A driver found confused after a crash has a glucose of 45 mg/dL and wakes after dextrose. What should you do next?

    1. A. Release him, since the cause has been found
    2. B. Give oral glucose and end the assessment
    3. C. Transport without any further injury assessment
    4. D. Complete a full trauma assessment for injuries
    Show answer

    Answer: D. Complete a full trauma assessment for injuries

    Finding one cause does not end the search (search satisficing). Hypoglycemia may have caused the crash, but he still needs a full trauma assessment, because confusion can hide injuries and the mechanism matters. Releasing him or skipping the exam risks missing internal injury.

22. A 19-year-old says she took 30 acetaminophen tablets 2 hours ago but feels fine. Why does she still need transport?

    1. A. Toxicity may be delayed, so she needs a level
    2. B. She feels well, so the dose must have been small
    3. C. Acetaminophen is only toxic when taken with alcohol
    4. D. She can be released if she promises to return
    Show answer

    Answer: A. Toxicity may be delayed, so she needs a level

    Acetaminophen causes few early symptoms, and liver injury appears 24 to 72 hours later. A 4-hour serum level guides acetylcysteine, which works best early. Feeling well now does not reflect the dose, acetaminophen is toxic without alcohol, and an intentional ingestion also needs a psychiatric and safety evaluation.

23. A crew delays transport of a STEMI patient to get a third set of vitals and a repeat glucose that will not change care. Which error is this?

    1. A. Information bias delaying care
    2. B. Appropriate thoroughness before leaving scene
    3. C. Omission bias from fear of acting
    4. D. Sunk cost bias from a long extrication
    Show answer

    Answer: A. Information bias delaying care

    Information bias is the belief that more data always helps, even when it will not change the decision. For STEMI, time to reperfusion drives outcome, so gather what changes care and transport. This is not omission bias (the crew is acting, just on the wrong things) or sunk cost.

24. A paramedic decides a young athlete's chest pain 'can't be cardiac because of age.' This error is:

    1. A. Hindsight bias about cardiac risk
    2. B. Representativeness/base-rate bias
    3. C. Commission bias toward cardiac workup
    4. D. Appropriate age-based risk stratification
    Show answer

    Answer: B. Representativeness/base-rate bias

    Judging by stereotype of the 'typical' patient can miss atypical but real conditions.

25. Which habit helps counter premature closure?

    1. A. Asking 'What's the worst this could be?'
    2. B. Committing early to the diagnosis that fits best
    3. C. Limiting the differential to the dispatch complaint
    4. D. Deferring diagnosis until hospital arrival
    Show answer

    Answer: A. Asking 'What's the worst this could be?'

    Forcing consideration of dangerous alternatives keeps the diagnostic process open. Then confirm that the worst-case diagnosis has been ruled out.

26. A patient with chest pain says, 'It's just my reflux again,' and the paramedic skips the 12-lead. Which error is this?

    1. A. Appropriate trust in the patient's history
    2. B. Correct use of pattern recognition
    3. C. A sound decision based on base rates
    4. D. Accepting the patient's framing untested
    Show answer

    Answer: D. Accepting the patient's framing untested

    Framing occurs when the way information is presented shapes your conclusion. Patients often attribute cardiac pain to reflux, so chest pain still needs a 12-lead and an ACS risk assessment. Respecting the patient's account does not mean accepting it without testing.

27. 'Ascertainment bias' occurs when thinking is shaped by:

    1. A. The most recent case of a similar complaint
    2. B. Prior expectations about the patient
    3. C. The accuracy of measured vital signs alone
    4. D. Written hospital policy and local protocols
    Show answer

    Answer: B. Prior expectations about the patient

    Preconceptions about who the patient is color the interpretation of findings.

28. A paramedic who follows a hunch without checking for contradictory signs is relying on:

    1. A. System 1 intuitive thinking without verification
    2. B. Deductive reasoning from first principles
    3. C. System 2 analytical thinking with verification
    4. D. Protocol-driven, rule-based reasoning from a checklist
    Show answer

    Answer: A. System 1 intuitive thinking without verification

    Fast intuitive (System 1) thinking is efficient but error-prone without analytic checking.

29. 'Commission bias' is the tendency to:

    1. A. Delegate decisions to the senior provider
    2. B. Withhold treatment to avoid causing harm
    3. C. Continue a plan because effort was invested
    4. D. Intervene even when action isn't indicated
    Show answer

    Answer: D. Intervene even when action isn't indicated

    The urge to 'do something' can lead to unnecessary or harmful interventions.

30. 'Omission bias' is the tendency to:

    1. A. Skip documentation of uneventful findings
    2. B. Omit history questions when time is short
    3. C. Favor inaction because action feels riskier
    4. D. Intervene because doing something feels better
    Show answer

    Answer: C. Favor inaction because action feels riskier

    Omission bias can delay needed treatment such as epinephrine in anaphylaxis. Harms of action feel worse than equivalent harms of inaction.

31. Handoff from a prior crew labels a patient 'anxiety.' The receiving paramedic's best approach is:

    1. A. Document anxiety and focus on calming the patient
    2. B. Accept the label, since the prior crew assessed first
    3. C. Assess independently before accepting the label
    4. D. Request a supervisor review before taking the patient
    Show answer

    Answer: C. Assess independently before accepting the label

    Independent assessment interrupts diagnosis momentum.

32. Right after a cardiac arrest, a paramedic's next patient (HR 118, SpO2 91%) seems 'minor' by comparison. Which bias is this?

    1. A. Omission bias
    2. B. Contrast effect
    3. C. Sunk cost bias
    4. D. Gambler's fallacy
    Show answer

    Answer: B. Contrast effect

    The contrast effect is judging a case against the one before it rather than on its own findings. Tachycardia with an SpO2 of 91% needs a full workup. Omission bias, sunk cost, and the gambler's fallacy describe other errors.

33. Which is an example of hindsight bias?

    1. A. Rechecking a reading after a monitor artifact
    2. B. Locking onto the dispatch complaint early
    3. C. Believing afterward that the outcome was obvious
    4. D. Predicting that a patient will soon deteriorate
    Show answer

    Answer: C. Believing afterward that the outcome was obvious

    Hindsight bias distorts learning from cases by making errors seem more avoidable than they were. The person feels the outcome should have been predicted.

34. Cognitive forcing strategies are:

    1. A. Policies requiring transport of every patient
    2. B. Techniques for eliciting a reluctant patient's history
    3. C. Built-in mental checks that catch bias
    4. D. Rigid protocols that remove clinical discretion
    Show answer

    Answer: C. Built-in mental checks that catch bias

    Forcing strategies make de-biasing habitual rather than optional. An example is a mandatory differential review.

35. The 'zebra retreat' error is:

    1. A. Retreating to protocol when a case is unusual
    2. B. Overlooking common conditions in rare settings
    3. C. Pursuing exotic diagnoses before common ones
    4. D. Abandoning a rare diagnosis as too unlikely
    Show answer

    Answer: D. Abandoning a rare diagnosis as too unlikely

    Sometimes the rare diagnosis IS right; dismissing it because it's rare is an error.

36. A good mitigation for availability bias is to:

    1. A. Recall similar recent cases in more detail
    2. B. Consider base rates for this population
    3. C. Trust the first diagnosis that comes to mind
    4. D. Treat the dispatch complaint as the diagnosis
    Show answer

    Answer: B. Consider base rates for this population

    Grounding likelihood in actual prevalence corrects for memorable but rare cases. Base rates are how common each diagnosis actually is in this population. Recalling recent cases in more detail and trusting the first diagnosis that comes to mind both feed availability bias rather than correcting it.

37. Dispatch reports 'intoxicated male.' On arrival you smell alcohol and focus on intoxication, missing that his glucose is 38 mg/dL. Which bias most influenced this error?

    1. A. Commission bias
    2. B. Anchoring bias
    3. C. Hindsight bias
    4. D. Omission bias
    Show answer

    Answer: B. Anchoring bias

    Locking onto the initial label of intoxication and failing to adjust is anchoring. Here the anchor was the dispatch information.

38. Last week you treated a dramatic case of aortic dissection. Today, every chest pain patient seems like a dissection to you. This is an example of:

    1. A. Premature closure
    2. B. Search satisficing
    3. C. Availability bias
    4. D. Framing effect
    Show answer

    Answer: C. Availability bias

    Recent, memorable cases make similar diagnoses seem more likely than they are, which is availability bias.

39. You suspect a patient's dyspnea is from asthma. You note his wheezing but discount his unilateral leg swelling and recent surgery. This is:

    1. A. Availability bias
    2. B. Authority gradient
    3. C. Confirmation bias
    4. D. Overtriage
    Show answer

    Answer: C. Confirmation bias

    Giving weight to supporting findings while discounting contradicting ones is confirmation bias.

40. A patient with a femur fracture is splinted. The crew stops assessing, missing a second injury: a tension pneumothorax developing en route. Which error occurred?

    1. A. Framing effect
    2. B. Commission bias
    3. C. Anchoring on dispatch
    4. D. Search satisficing
    Show answer

    Answer: D. Search satisficing

    Search satisficing is stopping the search once one finding explains part of the picture, missing additional problems.

41. A crew labels a patient with a known psychiatric history as having 'a panic attack' without examining him. He actually has a pulmonary embolism. This error is best described as:

    1. A. Hindsight bias
    2. B. Diagnostic overshadowing
    3. C. Representativeness bias
    4. D. Commission bias
    Show answer

    Answer: B. Diagnostic overshadowing

    Psychiatric labels can overshadow medical causes of symptoms, leading to missed serious illness. Here the psychiatric history overshadowed the medical cause.

42. A paramedic decides a 32-year-old woman's chest pain is 'not cardiac' because she is young and female, despite risk factors and diaphoresis. Which error is most evident?

    1. A. Availability bias
    2. B. Representativeness restraint
    3. C. Sunk cost bias in the plan
    4. D. Overconfidence in medical control
    Show answer

    Answer: B. Representativeness restraint

    Representativeness restraint occurs when providers dismiss a diagnosis because the patient doesn't match the typical prototype. The provider relies on a typical prototype and misses an atypical case.

43. The emergency department nurse tells you the patient 'is a frequent flyer and always faking.' During transport you dismiss his new complaint of weakness. Which bias is this?

    1. A. Omission bias
    2. B. Availability bias
    3. C. Hindsight bias
    4. D. Framing effect
    Show answer

    Answer: D. Framing effect

    How information is presented by others (the 'frame') can shape interpretation and lead to dismissing real findings.

44. A paramedic is 45 minutes into a difficult extrication and refuses to change the plan even though a faster option becomes available. This is best described as:

    1. A. Framing effect
    2. B. Sunk cost bias
    3. C. Representativeness
    4. D. Availability bias
    Show answer

    Answer: B. Sunk cost bias

    Sunk cost bias is continuing a course of action because of what has already been invested rather than what is best now.

45. After a bad outcome, a supervisor says the paramedic 'should have known' the patient had sepsis, even though the early findings were subtle. This judgment reflects:

    1. A. Anchoring
    2. B. Hindsight bias
    3. C. Search satisficing
    4. D. Commission bias
    Show answer

    Answer: B. Hindsight bias

    Hindsight bias makes outcomes seem more predictable after the fact than they were at the time.

46. A paramedic gives multiple unnecessary medications to an anxious, stable patient because 'doing something' feels better than watching. This tendency is:

    1. A. Commission bias
    2. B. Diagnostic momentum
    3. C. Availability bias
    4. D. Omission bias
    Show answer

    Answer: A. Commission bias

    Commission bias is the tendency toward action over inaction, even when action isn't beneficial.

47. A paramedic hesitates to give epinephrine to a patient in anaphylaxis because he fears side effects, even though it is clearly indicated. This tendency is:

    1. A. Overconfidence
    2. B. Anchoring
    3. C. Commission bias
    4. D. Omission bias
    Show answer

    Answer: D. Omission bias

    Omission bias is favoring inaction to avoid causing harm, even when action is indicated.

48. A patient says she is 'dizzy.' The paramedic assumes vertigo without asking what she means, and misses presyncope from a GI bleed. What went wrong?

    1. A. Appropriate use of pattern recognition
    2. B. Correct use of a clinical decision rule
    3. C. Failing to unpack a vague complaint
    4. D. Commission bias from overtreatment
    Show answer

    Answer: C. Failing to unpack a vague complaint

    'Dizzy' can mean vertigo, presyncope, imbalance, or vague weakness, each with different causes. Asking exactly what the patient means (unpacking the complaint) prevents premature closure. Presyncope should prompt questions about bleeding, dysrhythmia, and volume loss.

49. A paramedic worked a 24-hour shift with little sleep. At 0400 he skips the stroke scale on a confused patient. Which factor most contributed to this error?

    1. A. Fatigue-impaired cognition
    2. B. Authority gradient with partner
    3. C. Framing effect from dispatch
    4. D. Availability bias from prior calls
    Show answer

    Answer: A. Fatigue-impaired cognition

    Fatigue degrades attention and makes shortcuts and omissions more likely.

50. A patient's medical record lists 'chronic back pain.' He now reports severe back pain and leg weakness, and the crew attributes it to his chronic condition. This error is most likely:

    1. A. Diagnosis momentum
    2. B. Sunk cost bias
    3. C. Omission bias
    4. D. Commission bias
    Show answer

    Answer: A. Diagnosis momentum

    Labels attached earlier can gain momentum and keep providers from considering new conditions like cord compression or AAA. Here the momentum came from the existing 'chronic back pain' label.

51. Which statement about cognitive bias is most accurate?

    1. A. Knowing the bias names is enough to prevent them
    2. B. Only inexperienced paramedics are affected
    3. C. Experienced providers become immune over time
    4. D. All clinicians are susceptible to it
    Show answer

    Answer: D. All clinicians are susceptible to it

    Biases are universal features of human thinking; structured strategies are needed to counter them. Awareness alone does not eliminate bias.

52. A crew finds a cyclist with a minor scalp laceration and a helmet that is cracked through. They focus on the laceration and don't assess for head injury. Which bias best explains this?

    1. A. Hindsight bias about mechanism
    2. B. Commission bias toward wound care
    3. C. Premature closure on the obvious injury
    4. D. Overconfidence in the patient's history
    Show answer

    Answer: C. Premature closure on the obvious injury

    Accepting the first obvious diagnosis without considering the mechanism is premature closure.

53. A paramedic remains highly certain of a diagnosis despite being unable to explain several key findings. This is most consistent with:

    1. A. Omission bias
    2. B. Availability bias
    3. C. Overconfidence bias
    4. D. Sunk cost bias
    Show answer

    Answer: C. Overconfidence bias

    Overconfidence leads providers to overvalue their conclusions and underweight contrary data.

54. A patient appears disheveled and smells of urine. The paramedic assumes he is homeless and intoxicated and performs a limited exam. This is an example of:

    1. A. Fundamental attribution error
    2. B. Omission bias toward treatment
    3. C. Commission bias toward sedation
    4. D. Framing effect from a nurse
    Show answer

    Answer: A. Fundamental attribution error

    Attributing a patient's condition to personal characteristics rather than medical causes is the fundamental attribution error.

55. When is a brief 'diagnostic time-out' ('What else could this be?') most valuable during a call?

    1. A. Before committing to a destination or treatment
    2. B. After handoff, during the call review
    3. C. Once the patient is clearly improving
    4. D. Once the hospital has confirmed the final diagnosis
    Show answer

    Answer: A. Before committing to a destination or treatment

    A short pause at key decision points, such as before leaving the scene, choosing a destination, or giving a high-risk drug, catches anchoring and premature closure while you can still act. After hand-off it is too late. Improvement can hide a second problem, and waiting for the hospital's diagnosis comes too late to change field decisions.

56. A paramedic attributes a patient's tachycardia to pain from a wrist fracture and does not consider other causes. The patient was actually bleeding from a splenic injury. Which error occurred?

    1. A. Commission bias
    2. B. Premature closure
    3. C. Representativeness of age
    4. D. Hindsight bias
    Show answer

    Answer: B. Premature closure

    Settling on pain as the explanation before other causes are excluded is premature closure.

57. Which is an example of a 'cognitive forcing' strategy used in the field?

    1. A. A mandatory 'can't miss' checklist for syncope
    2. B. Skipping the history when the call volume is high
    3. C. Giving oxygen to every patient routinely
    4. D. Always transporting to the closest hospital
    Show answer

    Answer: A. A mandatory 'can't miss' checklist for syncope

    Cognitive forcing strategies prompt the provider to deliberately consider critical diagnoses, reducing bias. For example, reviewing 'can't miss' causes for every syncope patient.

58. A paramedic thinks, 'The last three chest pain calls tonight were reflux, so this one is bound to be cardiac.' This reasoning reflects:

    1. A. Appropriate base-rate reasoning
    2. B. Gambler's fallacy
    3. C. Sound deductive reasoning from prior cases
    4. D. Valid use of a clinical decision rule
    Show answer

    Answer: B. Gambler's fallacy

    The gambler's fallacy is believing that earlier independent events change the probability of the next one. The prior calls tell you nothing about this patient, whose risk depends on his own findings. (The original item described the opposite inference, 'all were reflux, so this one is too,' and keyed it as the gambler's fallacy, which is incorrect.)

59. Why is triage cueing a risk on busy shifts?

    1. A. It forces repeated triage that delays care
    2. B. It mainly causes errors in the radio report
    3. C. Early priority labels narrow what is noticed
    4. D. It applies only during mass-casualty incidents
    Show answer

    Answer: C. Early priority labels narrow what is noticed

    Triage cueing is when the initial category assigned shapes later thinking, potentially limiting assessment. A triage mindset can label priority too quickly so the provider sees only what fits. Triage cueing is not about repeated triage or radio errors; the risk is that an early label shapes what the crew notices afterward.

60. A crew transports an elderly woman with 'weakness' as low priority. En route, her 12-lead shows an acute MI they had not considered. Which error best explains the initial lapse?

    1. A. Overtriage of a vague complaint
    2. B. A correct triage decision for nonspecific weakness
    3. C. Missing an atypical ACS presentation
    4. D. Hindsight bias about the ECG finding
    Show answer

    Answer: C. Missing an atypical ACS presentation

    Older women and diabetics frequently present with atypical ACS symptoms such as weakness or fatigue. The crew failed to consider atypical presentations in older women. The crew undertriaged rather than overtriaged her. Hindsight bias is a later reviewer's error in judging the call, not the cause of the crew's initial lapse.

61. Which practice best helps prevent the 'visceral bias' of letting dislike of a patient influence care?

    1. A. Documenting the patient's behavior in detail
    2. B. Keeping the assessment brief to limit conflict
    3. C. Handing the patient to a partner without explanation
    4. D. Recognizing it and doing a standard full assessment
    Show answer

    Answer: D. Recognizing it and doing a standard full assessment

    Recognizing emotional reactions and committing to a systematic assessment limits the effect of visceral bias.