Multisystem Trauma and Team-based Resuscitation: Priorities, Leadership, and Communication Practice Questions

25 multiple-choice questions on Multisystem trauma and team-based resuscitation: priorities, leadership, and communication for paramedic and EMT students, from Chapter 41 (Management and Resuscitation of the Critical Patient). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. With four providers on a critically injured patient, the XABCDE steps should usually be done:

   1. A. Strictly one at a time in alphabetical order
   2. B. Only after the team leader finishes a full exam
   3. C. In whatever order the senior paramedic prefers
   4. D. At once, with tasks split among the team
   Show answer

   Answer: D. At once, with tasks split among the team

   A trained team assesses and treats several priorities simultaneously, such as one provider on the tourniquet and another on the airway, while the leader keeps the XABCDE order in mind. Doing each step in sequence wastes the extra hands.

2. A 35-year-old motorcyclist has a mangled thigh with brisk bleeding, snoring respirations, and an RR of 8. With two providers, the correct sequence is:

   1. A. Control the bleeding, then open the airway
   2. B. Open the airway, then control the bleeding afterward
   3. C. Start two large-bore IVs, then address the airway
   4. D. Complete a full secondary survey, then treat findings
   Show answer

   Answer: A. Control the bleeding, then open the airway

   Exsanguinating hemorrhage is addressed first because it kills fastest, and with a tourniquet that takes seconds, the airway follows immediately. In a larger team these are done simultaneously, but the ABC-first habit wastes blood.

3. A supervisor with more experience arrives in the middle of your resuscitation and wants to take over. The best way to change team leaders is to:

   1. A. Let her start giving orders right away
   2. B. Keep leading while she gives her own orders
   3. C. Brief her, then announce the change aloud
   4. D. Step away so she can assess from the start
   Show answer

   Answer: C. Brief her, then announce the change aloud

   A change of leader mid-resuscitation is a handover: the new leader needs a brief summary of findings, treatments, and the plan, and the team must hear clearly who is now in charge, or two people will give conflicting orders. Letting her give orders before she is briefed risks repeating or omitting treatments. Two leaders giving orders at once causes confusion. Stepping away loses what you know and makes her start over.

4. After a call, a paramedic tells a colleague: 'Twice today you pushed drugs without telling me. That worries me. Please call out each drug. That way we avoid a double dose.' In the DESC script, 'Please call out each drug' is the step of:

   1. A. Suggesting an alternative
   2. B. Describing the specific situation
   3. C. Expressing a concern
   4. D. Stating the consequences
   Show answer

   Answer: A. Suggesting an alternative

   DESC is a TeamSTEPPS tool for resolving conflict: Describe the specific situation, Express your concerns, Suggest other alternatives, and state the Consequences. 'Please call out each drug' proposes what to do differently, so it is the suggestion. 'Twice today you pushed drugs without telling me' describes the situation. 'That worries me' expresses the concern. 'That way we avoid a double dose' states the consequence.

5. A crew places its airway kit, suction, and monitor in the same positions around every critical patient. The main benefit is that:

   1. A. It satisfies an infection-control requirement
   2. B. Anyone can find each item fast under stress
   3. C. It removes the need for a team leader
   4. D. The crew can skip the equipment check
   Show answer

   Answer: B. Anyone can find each item fast under stress

   A standardized layout (a 'kit dump' in a set pattern) means every team member knows where the suction, bag-mask, and drugs are, which saves time and reduces errors when stress narrows attention. It is not an infection-control rule. It does not replace leadership. Equipment still needs checking before use, especially suction and oxygen.

6. An EMT has been holding firm pressure on a bleeding groin wound when paramedics arrive. The EMT should:

   1. A. Let go to give the paramedics a report
   2. B. Release it so the wound can be checked
   3. C. Let go and start setting up for an IV
   4. D. Keep holding until someone takes over
   Show answer

   Answer: D. Keep holding until someone takes over

   Pressure on a junctional wound is a life-saving task, so it continues until another provider takes it over or the wound is packed; the report can be given while pressure is held. Letting go to talk restarts bleeding that may not be controlled again. The wound is inspected when the next provider is ready to pack it, not by simply releasing pressure. Setting up for an IV is far less important than hemorrhage control.

7. A crash victim has an open, angulated tibia fracture, absent breath sounds on the right, distended neck veins, and a BP of 70/40 mmHg. Your first action should be to:

   1. A. Splint the leg to slow the bleeding
   2. B. Realign the leg to restore its pulse
   3. C. Decompress the right side of the chest
   4. D. Cover the open wound with a sterile dressing
   Show answer

   Answer: C. Decompress the right side of the chest

   Absent breath sounds, distended neck veins, and hypotension point to a tension pneumothorax, an immediate threat to life that is relieved by needle decompression. The open fracture threatens the limb and is treated after life threats, during packaging or en route. Splinting, realignment, and dressing the wound all matter, but none of them will reverse obstructive shock.

8. During RSI, one team member has the sole job of watching the monitor and calling out SpO2 and BP. This mainly helps because:

   1. A. The intubator's attention is on the airway
   2. B. Protocols require a witness for each RSI
   3. C. The caller alone decides when to abort the attempt
   4. D. It lets the alarms be silenced safely
   Show answer

   Answer: A. The intubator's attention is on the airway

   During laryngoscopy, the intubator's attention is fixed on the airway and time passes quickly, so a teammate who calls out falling saturation or pressure lets the team stop and reoxygenate or treat hypotension in time. Some protocols require documentation, but the purpose of this role is safety. The caller reports the numbers, while the decision to stop and reoxygenate stays with the intubator and leader, and alarms stay on as a backup. The monitor keeps recording during RSI.

9. A crew is focused on a difficult IV for 6 minutes while the patient's SpO2 drifts from 94% to 82% unnoticed. This error is best described as:

   1. A. Confirmation bias
   2. B. Normalcy bias
   3. C. Role confusion
   4. D. Task fixation
   Show answer

   Answer: D. Task fixation

   Task fixation is the loss of situational awareness while concentrating on a single task, so a hands-off leader who keeps watching the whole patient helps prevent it. Confirmation bias is favoring information that supports an existing diagnosis. Normalcy bias is underestimating a threat because things have usually turned out fine. Role confusion is uncertainty about who is doing what, which is not the problem here.

10. When moving an intubated patient from the floor to the stretcher, the move should be called by:

    1. A. The provider at the feet, who lifts the legs
    2. B. The provider at the head holding the tube
    3. C. The driver, from the front of the unit
    4. D. Whoever is ready to lift first
    Show answer

    Answer: B. The provider at the head holding the tube

    The provider at the head controls the airway and the cervical spine, can feel the tube move, and can see whether everyone is ready, so that provider counts the move; other providers and lines are checked before the count. A provider at the feet cannot protect the tube. The driver is not part of the lift. Lifting as soon as one person is ready leads to uncoordinated moves and dislodged tubes.

11. A trapped driver will need 20 minutes to extricate. He has life-threatening bleeding from a forearm wound you can reach. You should:

    1. A. Wait to treat the bleeding until he is out
    2. B. Apply a tourniquet now, inside the vehicle
    3. C. Start a fluid bolus before bleeding control
    4. D. Have him pulled out by the arm right away
    Show answer

    Answer: B. Apply a tourniquet now, inside the vehicle

    Life-threatening bleeding is treated as soon as it can be reached, and a tourniquet is the practical choice when you cannot hold pressure through a long extrication; airway and other critical care also start inside the vehicle. Waiting until he is out lets him bleed for 20 minutes. Fluid without hemorrhage control raises the pressure briefly and increases the bleeding. Pulling a trapped patient out by an injured arm is dangerous and does not stop the bleeding.

12. A second paramedic arrives halfway through your resuscitation of a patient in shock. As team leader, you should:

    1. A. Give a brief summary and a specific task
    2. B. Let her find a task that she sees needs doing
    3. C. Have her repeat the whole assessment
    4. D. Ask her to wait until you are free
    Show answer

    Answer: A. Give a brief summary and a specific task

    A new arrival works best when told quickly what is going on (findings, treatments, plan) and given a clear job, which keeps the team's picture shared and the work coordinated. Leaving her to find her own task risks duplication or a gap. Repeating the full assessment wastes time, although a fresh look can be assigned on purpose. Making her wait leaves help unused.

13. Before RSI drugs are drawn up, the leader asks the team to agree aloud on the patient's estimated weight. This mainly:

    1. A. Is needed to choose the laryngoscope blade
    2. B. Is needed to set the ventilator rate
    3. C. Gives every dose the same correct basis
    4. D. Is needed to size the endotracheal tube
    Show answer

    Answer: C. Gives every dose the same correct basis

    Weight-based drugs (induction agent, paralytic, and later infusions) are only as accurate as the weight used, and different team members may assume different numbers; agreeing on one figure aloud lets errors be caught before doses are drawn up. Blade and tube size depend on airway anatomy rather than weight, the ventilator rate is set by physiology, and tidal volume is based on height-derived ideal body weight. The dose check is still done.

14. Your protocol limits a crew to two attempts or about 90 seconds at any one procedure in a critical patient before moving to a backup plan. The main purpose is to:

    1. A. Spare the patient discomfort from repeat tries
    2. B. Reduce the cost of the supplies that are used
    3. C. Meet a legal limit on the number of attempts
    4. D. Stop one task from delaying all the others
    Show answer

    Answer: D. Stop one task from delaying all the others

    Repeated attempts at one procedure are a classic form of task fixation: while the crew focuses on one vein or one airway, oxygenation, transport, and other treatments wait. A preset limit makes the switch to a backup plan automatic. Comfort and supply costs matter, but they are minor concerns in a critical patient. There is no legal limit on attempts; the limit is a safety tool.

15. En route to a reported septic shock, the paramedic works out the push-dose epinephrine preparation and the norepinephrine rate in advance. This mainly:

    1. A. Cuts math errors made under stress
    2. B. Lets the crew skip the dose check
    3. C. Means the drugs act sooner once given
    4. D. Removes the need to confirm the weight
    Show answer

    Answer: A. Cuts math errors made under stress

    Calculations done in a calm moment before arrival are less error-prone than the same math done at the bedside amid noise and urgency, and they shorten the time to treatment. The dose and concentration still need to be checked before the drug is given, and the precalculated numbers rest on an estimated weight that must be confirmed at the bedside. Working the math early saves time to the first dose but does not make the drugs act any faster once given.

16. A crew has already given 2 units of prehospital blood to a patient in hemorrhagic shock. To help the trauma center prepare, they should:

    1. A. Wait to report until they arrive
    2. B. Report after the third unit is given
    3. C. Notify early so blood is ready on arrival
    4. D. Ask the hospital to send blood out to them
    Show answer

    Answer: C. Notify early so blood is ready on arrival

    Early notification with the mechanism, vital signs, and the blood given lets the trauma center activate its team and massive transfusion protocol, so blood and a surgeon are waiting when the patient arrives. Waiting until arrival loses the preparation time. There is no need to wait for a third unit. Hospitals do not send blood to the field for an ambulance already en route.

17. When a team uses an RSI checklist, the most effective method is that:

    1. A. The intubator reviews it silently alone
    2. B. One person reads each item; another confirms
    3. C. The team completes it after the tube is in
    4. D. Everyone reads their own part at the same time
    Show answer

    Answer: B. One person reads each item; another confirms

    A challenge-and-response checklist, with one person reading each item aloud and the responsible person confirming it, catches missing equipment, drugs, or plans before induction, when they can still be fixed. Reviewing it silently loses the cross-check by other team members. A checklist completed after the procedure cannot prevent omissions. Everyone reading at once creates noise and hides gaps.

18. With only two providers at a patient with two bleeding wounds and a failing airway, a calm bystander can best be used to:

    1. A. Drive the ambulance to the hospital
    2. B. Push IV medications under your direction
    3. C. Keep the other bystanders out of the way
    4. D. Hold firm pressure on a wound, as shown
    Show answer

    Answer: D. Hold firm pressure on a wound, as shown

    Direct pressure is simple to teach and frees a provider for the airway or the second wound, which is the best use of an untrained helper when hands are short. Driving the ambulance is not something an untrained bystander should do. Giving medications requires training and licensure. Crowd control is useful but does not address a life threat.

19. During a busy resuscitation, the leader asks everyone to stop side conversations before giving the next orders. This mainly ensures that:

    1. A. Closed-loop replies can be skipped
    2. B. Every task can be paused for the next order
    3. C. The leader appears to be in full control
    4. D. Orders are heard clearly and acted on
    Show answer

    Answer: D. Orders are heard clearly and acted on

    Noise and overlapping voices cause missed or misheard orders, so a brief call for quiet before key instructions makes communication reliable. Quiet makes closed-loop replies easier to hear rather than replacing them, and hands-on tasks such as compressions continue while the order is given. Appearing in control is not a reason by itself; reliable communication is.

20. When handing over a critical trauma patient at the emergency department, the recommended practice is to:

    1. A. Pause most activity while one person gives a structured report
    2. B. Give the report while the ED team moves the patient to their own bed
    3. C. Hand over the written run report and leave verbal details out
    4. D. Have each crew member report their own tasks at the same time
    Show answer

    Answer: A. Pause most activity while one person gives a structured report

    A brief 'hands-off' handover using a structured format such as MIST lets the receiving team listen once, without competing tasks, reducing lost information. Reports given during the transfer are often missed.

21. Near the end of a 24-hour shift, a crew is called to a critical patient. The best way to limit fatigue-related errors is to:

    1. A. Rely on experience and work faster
    2. B. Use checklists and cross-check doses
    3. C. Skip reassessments to save energy
    4. D. Have one person do all the drug math
    Show answer

    Answer: B. Use checklists and cross-check doses

    Fatigue impairs attention and memory much like alcohol, so a tired crew should lean harder on tools that do not depend on memory: checklists, read-backs, and independent dose checks. Working faster from experience is exactly when errors slip through. Skipping reassessments misses deterioration. One person doing all the math removes the cross-check that catches mistakes.

22. A septic patient stays hypotensive on maximal protocol norepinephrine, and your protocol does not cover a second vasopressor. The best action is to:

    1. A. Add a second pressor at your own dose
    2. B. Stop the pressor and just transport
    3. C. Contact medical control for direction
    4. D. Double the norepinephrine on your own
    Show answer

    Answer: C. Contact medical control for direction

    When a critical patient falls outside protocol, online medical control can authorize additional treatment or redirect care, and the decision and order are documented. Giving a drug or dose not covered by protocol on your own exceeds your authority. Stopping the pressor would worsen the hypotension. Doubling the dose without an order is also outside protocol.

23. A trauma patient's blood pressure falls despite blood and a controlled extremity wound. Using a team approach, the best next step is to:

    1. A. Increase the IV fluid rate without any further reassessment
    2. B. Add a vasopressor as the main treatment
    3. C. Delay transport until the pressure stabilizes
    4. D. Reassess for missed sources of bleeding or obstruction
    Show answer

    Answer: D. Reassess for missed sources of bleeding or obstruction

    An unexplained fall in pressure should prompt a structured reassessment for hidden bleeding (chest, abdomen, pelvis, long bones) and obstructive causes such as tension pneumothorax or tamponade. More fluid without reassessment can worsen bleeding and miss a treatable cause. Pressors do not treat the cause in trauma and can worsen hemorrhagic shock. Delaying transport for a patient with ongoing bleeding keeps him from surgery.

24. In a crowded scene with too many responders around a critical patient, the team leader should:

    1. A. Limit hands-on providers and assign roles
    2. B. Allow everyone present to help with any task
    3. C. Step away and let the crew sort out the roles
    4. D. Send all extra responders home without tasks
    Show answer

    Answer: A. Limit hands-on providers and assign roles

    Crowding increases noise and confusion and leads to duplicated or missed tasks; the leader assigns specific roles and asks extra providers to handle scene tasks or stand by. Sending everyone away can remove help that is needed for lifting or a second patient.

25. When assigning tasks during a resuscitation, the team leader should match:

    1. A. The hardest task to the newest member
    2. B. Every task to the single most senior provider
    3. C. Each task to a provider trained to do it
    4. D. Tasks to whoever is standing closest
    Show answer

    Answer: C. Each task to a provider trained to do it

    Assigning tasks according to each member's training and skill makes it likely the task is done correctly the first time, and the leader can still pair a less experienced member with a supervisor. Giving the hardest task to the newest member risks failure at a critical moment. Giving every task to the senior provider overloads one person and leaves others idle. Proximity alone ignores competence.