Crew Safety: Crashes, Restraint, Fatigue, Backing, and Highway Scenes Practice Questions

25 multiple-choice questions on Crew safety: crashes, restraint, fatigue, backing, and highway scenes for paramedic and EMT students, from Chapter 47 (Transport Operations). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Among the people riding inside an ambulance, which occupants are most likely to be seriously injured or killed in a crash?

   1. A. Belted drivers in the front cab
   2. B. Patients secured on the cot with straps and harness
   3. C. Belted family riders in the front seat
   4. D. Unbelted providers in the patient area
   Show answer

   Answer: D. Unbelted providers in the patient area

   Inside the ambulance, unrestrained providers working in the patient compartment have the highest rates of serious injury and death, because they are thrown into cabinets, bulkheads, and the cot. Belted drivers and belted front-seat riders are protected by seat belts and airbags, and a patient held by lap, chest, and shoulder straps on a locked cot is far better protected than an unbelted provider. (Counting everyone, occupants of the other vehicles make up about half of all deaths in fatal ambulance crashes, which is why this question asks only about ambulance occupants.) The lesson is to stay belted in the back whenever care allows.

2. A review of your agency's crashes shows that most happened at intersections during lights-and-siren responses. The most effective policy change is to:

   1. A. Limit lights and siren use with EMD criteria
   2. B. Increase the siren volume on the response units
   3. C. Add a third siren tone for use at intersections
   4. D. Raise speed to cut the time spent in crossings
   Show answer

   Answer: A. Limit lights and siren use with EMD criteria

   Fewer lights-and-siren runs means fewer high-risk intersection crossings, and EMD-based criteria target L&S to patients who benefit. Louder or extra siren tones do little because insulated cars block sound, and more speed raises crash severity.

3. The 'wake effect' of an ambulance running lights and siren refers to:

   1. A. The air turbulence behind a heavy vehicle
   2. B. A siren tone that fades away after passing traffic
   3. C. Crashes among drivers reacting to the unit
   4. D. Driver fatigue after several emergency runs
   Show answer

   Answer: C. Crashes among drivers reacting to the unit

   Startled drivers may brake, swerve, or pull out in response to an approaching ambulance, causing crashes the ambulance is not directly part of. The wake effect is a hidden cost of lights-and-siren use.

4. A provider caring for a patient in the back needs to reach a cabinet across the compartment while the ambulance is moving. The safest approach is to:

   1. A. Stand quickly while holding the overhead grab rail
   2. B. Ask the driver to slow or stop first
   3. C. Unbelt and kneel beside the cot to reach it
   4. D. Have the patient hand the item to you
   Show answer

   Answer: B. Ask the driver to slow or stop first

   If you must unbelt, alert the driver so the vehicle is slowed or stopped and keep the time unbelted short. Holding an overhead rail does not protect you in a crash or sudden stop.

5. A patient in heart failure must ride sitting fully upright on the cot. For restraint you should:

   1. A. Skip the harness, since it will not fit sitting up
   2. B. Use a lap strap and leave the chest free
   3. C. Have the patient hold the side rails instead
   4. D. Use the shoulder harness with the head raised
   Show answer

   Answer: D. Use the shoulder harness with the head raised

   Cot harnesses are designed to work with the backrest raised, and the shoulder straps keep an upright patient from being thrown forward. Leaving the chest free is exactly what lets a patient launch off the cot in a crash.

6. A healthy 4-year-old sibling of your patient has no other ride. Federal best-practice guidance says the child should ideally:

   1. A. Ride on the bench with the parent holding
   2. B. Sit on the cot at the patient's feet
   3. C. Go in another vehicle with a car seat
   4. D. Ride in the front seat with an adult belt
   Show answer

   Answer: C. Go in another vehicle with a car seat

   The NHTSA working group recommends that children who are not patients travel in another vehicle in a proper car seat. If that is impossible, the child goes in a size-appropriate restraint, never held or loose in the box, and not in a front seat with an airbag.

7. A 3-year-old with a fever needs transport. You do not have a pediatric restraint, but the child's mother has the child's car seat. The best option is to:

   1. A. Have the mother hold the child on her lap
   2. B. Secure the car seat to the cot per its design
   3. C. Lay the child flat on the cot with one strap
   4. D. Put the child in the front seat with an adult belt
   Show answer

   Answer: B. Secure the car seat to the cot per its design

   When no pediatric cot restraint is available, an intact, appropriate car seat can often be secured to the cot following ambulance and seat guidance. A child on a lap or loosely strapped on the cot is unprotected in a crash.

8. NAEMSP guidelines on fatigue in EMS personnel recommend:

   1. A. Shifts under 24 hours and on-duty napping
   2. B. Mandatory 36-hour shifts to reduce patient handoffs
   3. C. Caffeine bans for on-duty providers
   4. D. Ending overnight shifts in busy systems
   Show answer

   Answer: A. Shifts under 24 hours and on-duty napping

   The 2018 evidence-based fatigue guidelines recommend measuring fatigue, keeping shifts under 24 hours, allowing access to caffeine, allowing on-duty napping, and giving fatigue education. They do not ban caffeine or overnight work.

9. At 4 a.m., on the 20th hour of a shift, your partner nods off at a red light. The safest action is to:

   1. A. Turn up the radio and open the windows
   2. B. Finish the call, then report it at shift end
   3. C. Switch drivers or stop and report it
   4. D. Have your partner keep driving with a strong coffee
   Show answer

   Answer: C. Switch drivers or stop and report it

   Fatigue impairs driving as much as alcohol; the crew should change drivers or take the unit out of service and notify a supervisor. Radios, windows, and coffee do not reliably prevent sleep episodes. A driver who has nodded off once can do so again within seconds, so waiting until shift end to act leaves the risk in place.

10. A spotter backing an ambulance should stand at the:

    1. A. Left rear, visible in the driver's mirror
    2. B. Right front of the vehicle near the bumper
    3. C. Center of the rear, just behind the bumper
    4. D. Inside the patient compartment by the doors
    Show answer

    Answer: A. Left rear, visible in the driver's mirror

    The spotter stands at the left rear, slightly behind the unit, where the driver can see the spotter in the side mirror. Standing directly behind the bumper places the spotter in the vehicle's path.

11. While backing with a spotter, the driver loses sight of the spotter in the mirror. The driver should:

    1. A. Keep backing slowly and listen for a shout from behind
    2. B. Stop until the spotter is seen again
    3. C. Honk twice and continue backing
    4. D. Turn on the backup camera and continue
    Show answer

    Answer: B. Stop until the spotter is seen again

    If the spotter disappears from view, stop immediately; the spotter may have tripped or be in the path. Cameras help but do not replace a visible spotter.

12. Your new ambulance has a rear backup camera. When backing, the camera should be used:

    1. A. In place of a spotter on most backing moves
    2. B. At night, when mirrors are hard to use
    3. C. In place of mirrors when the spotter is visible
    4. D. With a spotter and mirrors, not in place of them
    Show answer

    Answer: D. With a spotter and mirrors, not in place of them

    Cameras have blind spots and can fog or glare, so they add to, rather than replace, a spotter and mirrors. Relying on the camera alone is a common cause of backing crashes.

13. Before a spotter guides you in backing, the two of you should first agree on:

    1. A. Hand signals, including a clear stop signal
    2. B. Who will write the crash report if needed
    3. C. How fast to back to save time on the call
    4. D. Whether to use the horn instead of signals
    Show answer

    Answer: A. Hand signals, including a clear stop signal

    Agreed signals, especially a stop signal that means stop at once, prevent confusion while backing. The horn cannot convey distance or direction.

14. Your ANSI high-visibility vest is faded, dirty, and torn. You should:

    1. A. Keep using it, since any vest meets the rule
    2. B. Replace it, since it is less visible
    3. C. Wear it under your jacket for warmth
    4. D. Add tape to the tears and keep using it
    Show answer

    Answer: B. Replace it, since it is less visible

    Fluorescent and retroreflective materials wear out with washing, sun, and damage, so a faded or torn vest no longer gives the required visibility. It also must be worn as the outer layer.

15. Compared with a city street, advance warning cones on a 65-mph highway should begin:

    1. A. Closer to the crash so the taper stays short
    2. B. At the same distance used on city streets
    3. C. Downstream, after traffic passes the scene
    4. D. Farther upstream, giving drivers more room
    Show answer

    Answer: D. Farther upstream, giving drivers more room

    At higher speeds, drivers need more distance to notice, slow, and merge, so warning signs and the cone taper start farther upstream. Starting them close to the crash gives fast traffic no time to react.

16. You arrive at an interstate crash in the right lane; a fire engine is blocking upstream. The ambulance should park:

    1. A. Upstream of the engine to add more protection for crews
    2. B. In the left lane opposite the crash
    3. C. Downstream of the crash, in the shielded zone
    4. D. On the median to stay away from traffic
    Show answer

    Answer: C. Downstream of the crash, in the shielded zone

    With the engine blocking upstream, the ambulance parks downstream so patients can be loaded in the protected zone and the unit can leave without backing. Parking upstream exposes the ambulance and crew.

17. A 'secondary crash' at a highway incident refers to:

    1. A. A second impact within the first crash
    2. B. A new crash caused by the first scene
    3. C. A crash of the ambulance on the way out
    4. D. A later crash at the same spot days after
    Show answer

    Answer: B. A new crash caused by the first scene

    Secondary crashes happen in the queue or at the scene as drivers slow or gawk, and they injure responders and motorists. Good traffic incident management, warning, and quick clearance reduce them.

18. The highway scene has cleared, and your crew is picking up the traffic cones. The safest way to do this is to:

    1. A. Keep your back to traffic so you work faster
    2. B. Leave them on the road for the next crew
    3. C. Collect them after the ambulance leaves
    4. D. Face oncoming traffic as you pick them up
    Show answer

    Answer: D. Face oncoming traffic as you pick them up

    Federal traffic incident guidance tells responders to face approaching traffic whenever they set out or pick up cones, so they can see an errant vehicle in time to move; cones are generally collected in the reverse of the order they were placed. Turning your back to traffic removes that warning, cones left in the road are a hazard and leave the roadway unrestored, and moving the ambulance away first removes its blocking protection while crew members are still in the roadway.

19. When loading a patient at a highway scene, the crew should load:

    1. A. From the side away from moving traffic
    2. B. From whichever side is closest to traffic
    3. C. In the travel lane to save time
    4. D. After moving the patient across traffic lanes
    Show answer

    Answer: A. From the side away from moving traffic

    Load on the protected side, away from traffic, so the crew is not standing in a live lane. Crossing traffic lanes with a patient puts everyone at risk.

20. A crew member steps out of the ambulance at a highway crash. The safest exit is:

    1. A. The traffic side door, which is faster and closer to the scene
    2. B. Through the rear doors in the travel lane
    3. C. The door away from traffic, after a mirror check
    4. D. Through any door, since warning lights are on
    Show answer

    Answer: C. The door away from traffic, after a mirror check

    Exit away from moving traffic after checking mirrors; many EMS line-of-duty deaths involve providers struck by passing vehicles. Warning lights do not stop distracted drivers.

21. 'Move over' laws in most states require drivers passing an emergency scene to:

    1. A. Change lanes or slow down near the scene
    2. B. Stop completely until the scene has cleared
    3. C. Follow the ambulance to the hospital
    4. D. Turn on their hazard flashers
    Show answer

    Answer: A. Change lanes or slow down near the scene

    Move-over laws require passing drivers to shift away from the stopped emergency vehicle or, if they cannot, to slow down. Crews should still assume drivers will not comply.

22. The driver sees he will need to brake hard for a stopped car ahead. To protect the provider in back, he should:

    1. A. Accelerate around it to avoid braking
    2. B. Tap the horn twice as a signal to the street
    3. C. Call out a warning to the crew in back
    4. D. Turn on the siren to clear the lane ahead
    Show answer

    Answer: C. Call out a warning to the crew in back

    A verbal warning lets the provider in back sit, belt, or brace before the stop. Swerving around at speed risks a rollover or collision, and horn or siren signals do not reach the crew.

23. Which sign most strongly suggests a driver is too drowsy to continue?

    1. A. Feeling bored on a quiet stretch
    2. B. Having had two cups of coffee
    3. C. Needing to stretch after a long transport call
    4. D. Drifting from the lane and missing exits
    Show answer

    Answer: D. Drifting from the lane and missing exits

    Lane drifting, missed turns, heavy eyelids, and gaps in memory are signs of dangerous drowsiness; the driver should stop and switch. Boredom, coffee intake, and stiffness after a long call are common and do not by themselves show that the driver is falling asleep.

24. Unsecured equipment in the cab, such as a laptop on the dashboard, is a hazard because it:

    1. A. Mainly a theft risk when parked at scenes
    2. B. Can strike occupants or block an airbag
    3. C. Can slide off and scratch the dashboard
    4. D. Can overheat in the sun and lose data
    Show answer

    Answer: B. Can strike occupants or block an airbag

    Loose objects in the cab become projectiles and may also obstruct airbag deployment. Laptops and radios should be mounted in crash-rated holders. Theft, scratches, and heat damage are minor concerns next to the injury a flying object or blocked airbag can cause.

25. An agency wants to reduce risky driving such as hard braking and speeding. Which tool has been shown to help?

    1. A. Louder sirens with more tone choices
    2. B. Larger mirrors on both sides of the unit
    3. C. In-vehicle monitoring with driver feedback
    4. D. Brighter paint on the ambulance body
    Show answer

    Answer: C. In-vehicle monitoring with driver feedback

    Onboard monitoring systems that give drivers real-time feedback on speed, braking, and cornering reduce risky driving and crashes. Louder sirens and brighter paint do not change driver behavior.