Loading and Securing Patients, Destination Choice, and Interfacility Transfer Practice Questions

25 multiple-choice questions on Loading and securing patients, destination choice, and interfacility transfer 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. Before loading a powered cot into an ambulance with a powered loading system, you should confirm that:

   1. A. The patient's straps are loosened for comfort during loading
   2. B. The rear doors are partly closed for privacy
   3. C. The cot is at its highest height setting
   4. D. The cot is engaged in the loader first
   Show answer

   Answer: D. The cot is engaged in the loader first

   Powered load systems lift and lock the cot only when it is properly engaged; lifting before engagement can drop the patient. Straps stay snug, and doors must be fully open for loading.

2. Your patient is on a raised cot beside the ambulance, and you need to grab a blanket from a side compartment. You should:

   1. A. Keep a provider at the cot the whole time
   2. B. Step away, since the wheel locks hold it
   3. C. Lock the wheels and leave it at full height
   4. D. Ask the patient to hold the side rails
   Show answer

   Answer: A. Keep a provider at the cot the whole time

   Cot makers warn never to leave a patient unattended on a cot: a raised cot has a high center of gravity and can tip on a slope, in wind, or when the patient shifts, and tip-overs injure patients. Have your partner stay with the cot, or lower it, before anyone steps away. Wheel locks keep the cot from rolling but do not stop it from tipping, full height makes it least stable, and a patient gripping the rails cannot stop a fall.

3. A cot rated to 700 lb holds a 220-lb patient. When lifting it into an ambulance without a powered loader, the crew should:

   1. A. Lift with a bent back and straight legs
   2. B. Use a coordinated lift with good mechanics
   3. C. Have each rescuer lift on his or her own count
   4. D. Tilt the cot sideways to fit the doorway
   Show answer

   Answer: B. Use a coordinated lift with good mechanics

   Without a powered loader, two or more providers lift together on a count, keeping the back straight and the load close. Bending at the back with straight legs strains the spine, lifting without a shared count leaves one rescuer holding the load, and tilting the cot sideways risks dropping the patient.

4. A 75-year-old with a hip fracture is on the cot and complains the straps are tight. The best response is to:

   1. A. Remove the chest strap for the short ride
   2. B. Leave only the leg strap on the injured side in place
   3. C. Loosen all straps until arrival
   4. D. Adjust them but keep every strap secured
   Show answer

   Answer: D. Adjust them but keep every strap secured

   Straps can be adjusted to avoid pressure on injuries, but the shoulder, chest, and leg restraints must remain in place. Removing straps leaves the patient unprotected in a sudden stop.

5. A 58-year-old with a left ventricular assist device (LVAD) has dizziness but stable vital signs. The best destination is usually:

   1. A. The closest community hospital ED
   2. B. An urgent care center near his home
   3. C. The hospital that manages his LVAD
   4. D. Any hospital with a cardiology clinic
   Show answer

   Answer: C. The hospital that manages his LVAD

   LVAD centers have the team and equipment to manage pump problems, so stable patients are usually taken there. An unstable patient goes to the closest ED, but a general cardiology clinic cannot manage the device.

6. A 35-year-old has a clean thumb amputation from a table saw and stable vital signs. Your region has a designated replantation center 30 minutes away. In many systems, you should take him to:

   1. A. The replantation center, with the part cooled
   2. B. The closest ED, with the part cooled
   3. C. An urgent care clinic, with the part cooled
   4. D. The replant center, leaving the part on scene
   Show answer

   Answer: A. The replantation center, with the part cooled

   Replantation needs microsurgical teams found only at designated centers, so many systems send a stable replant candidate straight there; the part travels with him, wrapped in moist gauze, sealed in a bag, and kept cool without direct contact with ice. The closest ED usually cannot replant and would only add a transfer and delay, an urgent care clinic cannot manage an amputation, and leaving the part behind makes replantation impossible.

7. Under EMTALA, a burn center with open beds and staff is asked to accept an unstable man with major burns from a small hospital that has no burn unit. The burn center:

   1. A. May refuse if the patient is uninsured
   2. B. Must accept him if it has the capacity
   3. C. May refuse if it is far from the patient
   4. D. May decline unless he is its own patient
   Show answer

   Answer: B. Must accept him if it has the capacity

   Under 42 CFR 489.24(f), a hospital with specialized capabilities such as a burn unit may not refuse an appropriate transfer of a patient who needs those capabilities when it has the capacity to treat him. Insurance status is never a valid reason to refuse; the duty applies to transfers from anywhere in the United States, however far away; and it does not depend on the patient having been treated there before.

8. A hospital announces that it is on diversion for ambulance traffic. A patient with a cardiac arrest occurs 2 minutes from that hospital. In most systems, you should:

   1. A. Follow local protocol, which often exempts arrests
   2. B. Drive past and go to an open hospital 20 minutes away
   3. C. Wait on scene until diversion ends
   4. D. Ask the family which hospital to use
   Show answer

   Answer: A. Follow local protocol, which often exempts arrests

   Diversion policies usually exclude unstable patients such as those in arrest or with an unsecured airway, which go to the closest emergency department. Driving far past a nearby ED risks worse outcomes.

9. A hospital that violates EMTALA can face:

   1. A. Loss of its state nursing licenses
   2. B. Automatic closure of its emergency department
   3. C. Criminal charges for the ED nursing staff
   4. D. Fines and loss of Medicare provider status
   Show answer

   Answer: D. Fines and loss of Medicare provider status

   EMTALA violations can bring civil fines for hospitals and physicians and termination of the Medicare provider agreement. They do not automatically close the ED or revoke staff licenses.

10. Under EMTALA, a patient arriving by ambulance is considered to have come to the emergency department when:

    1. A. The patient is registered by the clerk
    2. B. A physician first examines the patient in the department
    3. C. The ambulance arrives on hospital property
    4. D. The patient is placed in an ED bed
    Show answer

    Answer: C. The ambulance arrives on hospital property

    EMTALA obligations begin when the patient arrives on hospital property, including the ambulance bay. A hospital cannot refuse or delay screening by leaving the patient on the EMS cot.

11. An unstable patient asks to be transferred to the hospital where her doctors practice. Under EMTALA, the transfer may occur if she:

    1. A. Pays for the ambulance before departure
    2. B. Requests it in writing, knowing the risks
    3. C. Has insurance accepted by both hospitals
    4. D. Signs a waiver that releases the ambulance crew
    Show answer

    Answer: B. Requests it in writing, knowing the risks

    An unstable patient may be transferred at her own informed, written request after being told the risks and benefits; the other route is a physician's certification. Payment or insurance can never be a condition.

12. Under EMTALA, a hospital must keep a list of on-call physicians so that:

    1. A. Paramedics know whom to call for medical control
    2. B. Patients can choose their own surgeon in the ED
    3. C. Specialists can come to help stabilize patients
    4. D. Insurers can approve care before treatment begins
    Show answer

    Answer: C. Specialists can come to help stabilize patients

    Hospitals must maintain an on-call list so specialists can respond to evaluate and stabilize ED patients. Medical control is a separate system, and insurer approval cannot delay screening or stabilization.

13. Under EMTALA, the decision about the level of transport and staffing for an interfacility transfer is made by the:

    1. A. Transporting paramedic
    2. B. Sending physician
    3. C. Receiving physician
    4. D. Patient's insurer
    Show answer

    Answer: B. Sending physician

    EMTALA makes the sending physician responsible for choosing the level of care, staffing, and equipment needed for the transfer. The receiving physician accepts the patient but does not set the mode of transport, and insurance coverage never determines the medical needs of the transfer.

14. Before an interfacility transfer, you see that the written orders for a drip are unclear about the rate. You should:

    1. A. Clarify them with the sending physician first
    2. B. Run it at the rate shown on the pump today
    3. C. Leave and call the receiving hospital later
    4. D. Stop the infusion until you reach the hospital
    Show answer

    Answer: A. Clarify them with the sending physician first

    Clear, written orders for each infusion are part of a safe transfer, and questions should be settled before you leave. Guessing from the pump or stopping the drip can harm the patient.

15. A patient is being flown by fixed-wing aircraft between two cities. The transfer also needs:

    1. A. A ground unit at the sending airport alone
    2. B. A helicopter at each end of the flight
    3. C. A police escort for the entire trip
    4. D. Ground ambulances at both airports
    Show answer

    Answer: D. Ground ambulances at both airports

    Fixed-wing aircraft need runways, so a bed-to-bed transfer uses a ground ambulance from the sending hospital to the airport and another from the destination airport to the receiving hospital. Both ends need a ground leg, and helicopters are not routinely added when ground ambulances can make the trip. A police escort is not part of a standard transfer.

16. During an interfacility transfer, your patient becomes hypotensive. The sending physician's orders do not address this. You should:

    1. A. Return to the sending hospital at once
    2. B. Follow your protocols and call medical control
    3. C. Continue without treatment, following the written orders
    4. D. Call the patient's primary care doctor
    Show answer

    Answer: B. Follow your protocols and call medical control

    When the patient's condition changes, treat according to your protocols and contact medical direction, and consider diverting to the nearest ED if needed. The orders do not prevent appropriate emergency care.

17. A stable 82-year-old needs transport from a nursing home to a dialysis appointment. Before transport, you should confirm:

    1. A. A copy of the patient's insurance card
    2. B. The address of the patient's family home
    3. C. Advance directives and code status orders
    4. D. Whether a helicopter is available
    Show answer

    Answer: C. Advance directives and code status orders

    Copies of DNR or POLST forms travel with the patient so care matches the patient's wishes. Family address and helicopter availability are not relevant to a stable scheduled transfer.

18. A patient in labor with contractions 2 minutes apart is being transferred to a hospital 45 minutes away. Before departure, the sending physician should:

    1. A. Judge the transfer safe and arrange support
    2. B. Send her without an exam to avoid any delay in transfer
    3. C. Require her to sign a payment agreement
    4. D. Send her by private car to save time
    Show answer

    Answer: A. Judge the transfer safe and arrange support

    EMTALA covers women in active labor; transfer requires that the patient be stabilized (which in labor can mean delivery) or that the benefits outweigh the risks, with appropriate staff. Payment can never be required before care.

19. A patient on a ventilator needs transfer between two hospitals. The most appropriate transport is:

    1. A. A BLS ambulance with a bag-valve mask
    2. B. A wheelchair van with an oxygen cylinder and a driver
    3. C. A private car with family members
    4. D. A critical care unit with a ventilator
    Show answer

    Answer: D. A critical care unit with a ventilator

    Ventilated patients need staff trained in ventilator management and equipment to monitor them, usually a critical care transport team. A BLS crew cannot manage a ventilated patient.

20. Your ambulance has waited 60 minutes at the ED with a stable patient on your cot, and calls are holding. The best action is to:

    1. A. Leave the patient on the cot in the hall
    2. B. Take the patient to another hospital
    3. C. Notify a supervisor to work with the ED
    4. D. Ask the patient to wait in the lobby alone
    Show answer

    Answer: C. Notify a supervisor to work with the ED

    Prolonged offload delays are resolved by supervisors and hospital leaders using local policy; the crew stays with the patient until care is transferred. Leaving the patient is abandonment.

21. A 30-year-old is intoxicated with alcohol but has normal vital signs, no injuries, and a normal glucose. Your system has an approved sobering center. Under such a protocol, he may be taken to:

    1. A. The ED, because EMS may not use other sites
    2. B. The sobering center, if he meets its criteria
    3. C. Jail, since public intoxication is a crime
    4. D. A homeless shelter, based on the crew's judgment
    Show answer

    Answer: B. The sobering center, if he meets its criteria

    Alternative destination programs let EMS take selected low-acuity patients, such as stable intoxicated patients who pass a medical screening checklist, to sobering centers, mental health crisis centers, or urgent care. Patients with abnormal vital signs, injuries, hypoglycemia, or other red flags still go to an ED. Where an approved program exists, the ED is not the sole legal destination, and a shelter is not an approved medical destination without a protocol. Public intoxication is not a crime in many states, and jail is not a medical destination.

22. A 25-year-old with a minor laceration asks to go to a hospital in a neighboring county 50 minutes away. Your protocol limits elective destinations to 20 minutes. You should:

    1. A. Explain the limit and offer a closer hospital
    2. B. Take her to the far hospital anyway, since she is stable
    3. C. Refuse to transport her anywhere
    4. D. Ask her to call a taxi instead
    Show answer

    Answer: A. Explain the limit and offer a closer hospital

    Patient choice is honored within protocol limits that preserve unit availability. Explain the options and transport to an in-range facility; refusing transport entirely is not appropriate.

23. During an interfacility transfer, your patient wishes to go to a different hospital than the one that accepted him. You should:

    1. A. Go to the patient's choice without notifying anyone
    2. B. Continue and ignore the patient's request
    3. C. Stop the ambulance and let him out
    4. D. Contact the sending physician and medical control
    Show answer

    Answer: D. Contact the sending physician and medical control

    A transfer is arranged physician to physician with an accepting facility; a change in destination needs coordination. Changing destination without notice may leave the patient where no physician has accepted him.

24. Under EMTALA, a hospital-owned ambulance that picks up a patient in the community generally must:

    1. A. Bring the patient there if the patient is insured
    2. B. Transfer the patient to a public hospital
    3. C. Take the patient to its own hospital
    4. D. Drop the patient at the nearest clinic
    Show answer

    Answer: C. Take the patient to its own hospital

    A hospital-owned ambulance is considered part of the hospital under EMTALA, so a patient in it has 'come to the ED' unless it operates under community-wide EMS protocols directing it elsewhere. Insurance status is never a factor.

25. A freestanding emergency department is near your scene. Compared with a hospital ED, it typically lacks:

    1. A. Physicians who can treat emergencies
    2. B. Lab tests and CT imaging on site
    3. C. An ability to give IV medications
    4. D. Inpatient beds and on-site surgery
    Show answer

    Answer: D. Inpatient beds and on-site surgery

    Freestanding EDs have emergency physicians, labs, and often CT, but no inpatient units, operating rooms, or cath labs. Patients likely to need surgery, PCI, or thrombectomy should go to a full hospital per protocol.