Patient Care During Extrication Practice Questions

25 multiple-choice questions on Patient care during extrication for paramedic and EMT students, from Chapter 49 (Vehicle Extrication and Special Rescue). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The interior rescuer's main job during an extrication is to:

   1. A. Stay with, protect, and care for the patient
   2. B. Run the hydraulic tools from inside the car
   3. C. Direct the cuts that the rescue team makes
   4. D. Clear broken glass from the inside of the car
   Show answer

   Answer: A. Stay with, protect, and care for the patient

   The interior rescuer, often a paramedic, stays with the patient to assess, treat, shield, and reassure him and to tell the rescue team about his condition. Tool work and the extrication plan belong to the rescue crew outside.

2. A paramedic should enter a crashed car to begin patient care:

   1. A. As soon as the ambulance arrives on scene
   2. B. After the patient has been fully disentangled
   3. C. Once the car is stabilized and safe to enter
   4. D. Once every airbag module has been removed
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   Answer: C. Once the car is stabilized and safe to enter

   Entry waits for stabilization and hazard control, and then care begins early, long before the patient is freed. Waiting for full disentanglement delays airway, bleeding, and spinal care, while airbags are managed by staying out of their path rather than removing them.

3. Rescuers are about to break the window next to a trapped driver. The interior rescuer should first:

   1. A. Cover him with a blanket and a hard shield
   2. B. Have him turn his face toward the window
   3. C. Remove his collar so that he can turn his head
   4. D. Leave the car until the glass is cleared
   Show answer

   Answer: A. Cover him with a blanket and a hard shield

   A tarp or blanket over the patient and a rigid barrier such as a short board between him and the glass or tool protect him from fragments and cuts. Turning toward the window exposes his face, and the interior rescuer normally stays with the patient, covered as well.

4. Which item gives a trapped patient the best protection for the eyes from flying glass and debris?

   1. A. Gauze pads taped firmly over both closed eyes
   2. B. Turning the patient's head to one side
   3. C. Goggles or safety glasses on the patient
   4. D. A towel draped loosely over his helmet
   Show answer

   Answer: C. Goggles or safety glasses on the patient

   The patient is as exposed to glass, dust, and metal fragments as the rescuers and needs real eye protection. Taping pads over the eyes leaves him unable to see and frightened, and a loose towel slips off when he moves.

5. A trapped woman is anxious as rescuers prepare to cut off the roof. The best way to communicate with her is to:

   1. A. Avoid mentioning the tools so that she stays calm
   2. B. Promise her the rescue will take two minutes
   3. C. Let the tool operator explain after cutting
   4. D. Explain each step and warn her before loud noise
   Show answer

   Answer: D. Explain each step and warn her before loud noise

   Telling the patient what is about to happen, especially before loud cutting or glass breaking, reduces fear and helps her hold still. Avoiding the subject leaves her startled when the noise starts, and promises about timing that cannot be kept damage trust.

6. Two people are trapped. The front passenger is pinned and unstable; the alert, uninjured-appearing rear passenger behind her blocks your access. The best plan is to:

   1. A. Put a vest-type device on the rear passenger
   2. B. Rapidly extricate the rear passenger first
   3. C. Treat the front passenger over the seat back
   4. D. Wait for the roof to come off to reach both
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   Answer: B. Rapidly extricate the rear passenger first

   Rapid extrication is used when a stable patient blocks access to a more critical one, or when a scene hazard or the patient's own condition will not allow the time for a vest-type device. Packaging the rear passenger fully would delay care for the unstable front passenger.

7. A driver's legs have been pinned under the dash for 20 minutes. His lower legs have deep lacerations that are oozing only a little. Just before rescuers lift the dash, you should be ready for:

   1. A. Brisk bleeding once the pressure is relieved
   2. B. A sudden rise in his blood pressure
   3. C. Immediate return of normal feeling in his legs
   4. D. His pain easing as soon as the dash moves
   Show answer

   Answer: A. Brisk bleeding once the pressure is relieved

   Wreckage pressing on a limb can hold wounds closed and hide how much they will bleed. When the dash comes off, that pressure is gone and bleeding can start quickly, so dressings, a tourniquet, and IV access should be ready before the lift. Blood pressure is more likely to fall than rise as bleeding resumes and blood refills the freed limbs. Feeling does not return the moment the pressure is gone, because nerve and tissue injury persist. Moving freed, injured legs usually increases pain, which is why analgesia is given before the release.

8. Compared with a standard extrication using a vest-type device, rapid extrication trades:

   1. A. Some speed for better spinal protection
   2. B. Some spinal protection for speed
   3. C. Patient comfort for less rescuer effort
   4. D. Rescuer safety for patient comfort
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   Answer: B. Some spinal protection for speed

   Rapid extrication moves the patient in a few coordinated steps with manual spinal support, accepting less stabilization than a vest-type device to save time. It is chosen when the time a vest-type device would take could cost the patient's life.

9. A trapped driver's head is slumped forward, and he has snoring respirations. Rescuers need 15 more minutes. Your first action is to:

   1. A. Wait until he is out to treat the airway
   2. B. Insert a tube through the side window
   3. C. Open his airway with a jaw thrust
   4. D. Give naloxone 2 mg IN for the snoring
   Show answer

   Answer: C. Open his airway with a jaw thrust

   Snoring means a partly blocked upper airway, and a jaw thrust with the head held in line opens it right away; airway care cannot wait for disentanglement. Intubation may come later if needed, and naloxone is not the first step without signs of opioid use.

10. A patient is pinned with both legs crushed under the dash, and you cannot find a vein in his arms. The best vascular access is:

    1. A. A tibial IO line in a pinned leg
    2. B. A distal femur IO line on one side
    3. C. Waiting until he is freed from the car
    4. D. A proximal humerus IO line
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    Answer: D. A proximal humerus IO line

    The proximal humerus is reachable in a seated, trapped patient and gives fast access above the injury. A tibial or femoral IO in a crushed, pinned leg may lose fluid into damaged tissue and is hard to reach.

11. Why should oxygen flow inside a car be watched closely while rescuers use a power saw on the vehicle?

    1. A. Saw sparks plus extra oxygen raise fire risk
    2. B. Oxygen makes the airbags more likely to fire
    3. C. The saw's exhaust mixes with the oxygen
    4. D. Oxygen is wasted in the open, cut vehicle
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    Answer: A. Saw sparks plus extra oxygen raise fire risk

    Sparks from saws and grinders can ignite materials in an oxygen-enriched space, so oxygen delivery should be kept to the patient and not allowed to build up in the car. Oxygen does not affect airbag firing.

12. A basic principle of disentanglement is to:

    1. A. Pull the patient free of the wreckage by hand
    2. B. Bend the patient to fit the opening
    3. C. Remove the vehicle from around the patient
    4. D. Cut the seat belt before the last cut
    Show answer

    Answer: C. Remove the vehicle from around the patient

    Rescuers cut and move the vehicle away from the patient rather than forcing the patient through a small opening, which protects the spine and injured limbs. Pulling a patient free of wreckage can tear tissue and worsen fractures.

13. After the roof is removed, a seated patient with a suspected spine injury is best removed by:

    1. A. Twisting him out through the driver's door
    2. B. Sliding him up onto a board along his long axis
    3. C. Rolling him sideways onto a board on the seat
    4. D. Using a vest device and pivoting him out the door
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    Answer: B. Sliding him up onto a board along his long axis

    With the roof off, the seat back can be lowered and the patient slid straight back and up onto a board, keeping the spine in line. Twisting through a door, even in a vest device, and rolling him sideways move the spine in ways roof removal is meant to avoid.

14. To lay a seated driver back onto a long board through the rear of the car, rescuers can:

    1. A. Remove the steering wheel first
    2. B. Lift the patient above the seat
    3. C. Turn the seat to face the door
    4. D. Recline or cut the seat back
    Show answer

    Answer: D. Recline or cut the seat back

    Lowering or cutting away the seat back lets the patient be eased straight back onto a board in line with the spine. Lifting the patient over the seat is harder on rescuers and moves the spine more.

15. As a door is spread open, the interior rescuer sees its inner edge moving toward the trapped patient's injured knee. The tool operator cannot see the knee. The interior rescuer should:

    1. A. Hold the door back by hand while the tool runs
    2. B. Call a clear stop so the operator halts the tool
    3. C. Let the spread finish, then report what happened
    4. D. Pull the leg clear while the tool keeps moving
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    Answer: B. Call a clear stop so the operator halts the tool

    The interior rescuer is the team's eyes on the patient, and any rescuer who sees an immediate danger calls a clear stop so that the operator halts the tool before metal reaches the patient. The plan can then be changed, for example by padding or moving the tool. Holding a door back by hand puts the rescuer's hand against hydraulic force that no person can resist, in a crush point. Waiting until the spread is finished lets the injury happen. Pulling an injured, possibly pinned leg while metal is still moving can worsen the fracture and put the rescuer's hands in the path.

16. A pedestrian is trapped under a car's frame. Rescuers will raise the car with air lifting bags. While it is being raised, they must:

    1. A. Lift it as high as the bags allow
    2. B. Pull the patient out during the lift
    3. C. Remove the cribbing before the lift
    4. D. Crib under the load as it rises
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    Answer: D. Crib under the load as it rises

    'Lift an inch, crib an inch': cribbing follows the load up so that if a bag fails, the car drops only a short distance. Pulling the patient out from under an unsupported car risks a sudden drop.

17. A trapped, alert, and oriented driver refuses to let you start an IV during the extrication. You should:

    1. A. Start it anyway since he cannot leave the car
    2. B. Ask medical control to approve the IV over his refusal
    3. C. Respect the refusal, explain the risks, and recheck
    4. D. Have his family sign consent for the IV
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    Answer: C. Respect the refusal, explain the risks, and recheck

    Being trapped does not remove an alert, capable adult's right to refuse a procedure; you explain why the IV matters and keep assessing for changes in his capacity. Starting it anyway is battery. Medical control cannot override a capable adult's refusal, and family members cannot consent for an adult who can decide for himself.

18. A pinned driver becomes pulseless from blunt trauma, and freeing him will take 20 minutes. The main problem with resuscitating him in the seat is that:

    1. A. Effective compressions cannot be given there
    2. B. Defibrillation is unsafe inside a car
    3. C. A cardiac monitor cannot be attached
    4. D. An advanced airway cannot be placed while he sits
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    Answer: A. Effective compressions cannot be given there

    High-quality CPR needs a supine patient on a firm surface, which a seated, trapped patient does not allow, and traumatic arrest with prolonged entrapment has a very poor outcome. Pads can be placed and a shock given safely in a car if no one touches the patient or metal in contact with him. A monitor attaches in the seat as easily as anywhere, and a supraglottic airway or even intubation can be placed in a seated patient.

19. While a patient is still trapped, the assessment you can do in the car should focus on:

    1. A. A detailed head-to-toe exam of every body region first
    2. B. The primary survey and life threats you can reach
    3. C. A full medical history before any treatment
    4. D. Vital signs, saving the whole exam for later
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    Answer: B. The primary survey and life threats you can reach

    In the car, space and access are limited, so the paramedic finds and treats immediate threats to airway, breathing, circulation, and bleeding and rechecks often. A full secondary exam is done after removal, when the whole body can be seen.

20. A driver is pinned at the legs. She is alert, and her vital signs are stable. Disentanglement will take 15 minutes. Appropriate care in the car includes:

    1. A. Leaving her alone until the rescuers have freed her
    2. B. A full set of traction and long bone splints
    3. C. Oxygen as needed, IV access, and frequent rechecks
    4. D. Giving her sips of water to keep her hydrated
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    Answer: C. Oxygen as needed, IV access, and frequent rechecks

    Stable patients still get care during entrapment: oxygen if indicated, IV access in case she deteriorates, and repeated vital signs. Food and drink are avoided because she may need surgery and sedation.

21. A car is on its side with the driver hanging from the seat belt. Before the belt is cut, you should:

    1. A. Ask him to pull himself free of the belt
    2. B. Move his seat back to give him more room
    3. C. Cut the belt at the buckle, then catch him
    4. D. Support his weight so he does not drop
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    Answer: D. Support his weight so he does not drop

    If the belt is cut with no one holding the patient, he falls onto the door or glass below, which can worsen spinal and other injuries. Rescuers support the patient's body and head first, then release the belt.

22. Before the last cut that frees the patient, the team should already have:

    1. A. The removal path and packaging ready
    2. B. A full head-to-toe exam completed
    3. C. The hospital's trauma team on the line
    4. D. Every airbag module removed from the car
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    Answer: A. The removal path and packaging ready

    Planning the exit route and having the board, stretcher, and crew in place lets removal follow disentanglement without delay. Calling the hospital can wait until care and removal are under way. A full head-to-toe exam usually waits until he is out, and rescuers do not remove airbag modules; they avoid undeployed airbags and respect their deployment zones.

23. During a 40-minute extrication of a patient with major trauma in a rural area, air medical transport is requested early so that:

    1. A. The flight crew can take over incident command
    2. B. The aircraft arrives as he is being freed
    3. C. Air is faster than ground over short distances
    4. D. The request can be canceled if he dies
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    Answer: B. The aircraft arrives as he is being freed

    Requesting a helicopter early, when entrapment is expected to be long, lets the aircraft land and the crew be ready when the patient is freed, so transport is not delayed. The flight crew joins the operation under the existing command rather than taking it over, and for short distances ground transport is often as fast once lift-off and landing are counted.

24. A driver's chest is pinned by the steering column, and his breathing is fast and shallow. His legs are also trapped. When the rescue officer asks what to free first, you should ask for:

    1. A. His legs to be freed first so he can be moved
    2. B. The roof to be removed before the column
    3. C. The column to be left in place to splint his chest
    4. D. The column to be moved off his chest first
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    Answer: D. The column to be moved off his chest first

    Breathing comes before limb injuries. A column pressing on the chest keeps it from expanding, so moving the column off the chest (a column or steering wheel displacement) is the first goal, and it also gives more room for airway care. Freeing the legs first leaves the life threat in place for the whole time it takes. Roof removal may help with the later removal, but it takes time and does not take the pressure off his chest. A column pressing on the chest does not splint it: it limits breathing, and the longer the compression lasts, the worse the outcome.

25. Rescuers will need to move a trapped patient's open, angulated forearm fracture to free her arm. Before the arm is moved, you should:

    1. A. Splint or support it in place if you can
    2. B. Straighten it with traction to free it
    3. C. Pull the arm free while she holds still
    4. D. Wait to splint it until she is out of the car
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    Answer: A. Splint or support it in place if you can

    Supporting or splinting the injured limb before it is moved reduces pain, bleeding, and further damage during the release. Pulling or straightening it before stabilization can tear vessels and nerves.