Tactical EMS, Working with Law Enforcement, and Patients in Custody Practice Questions

25 multiple-choice questions on Tactical EMS, working with law enforcement, and patients in custody for paramedic and EMT students, from Chapter 53 (Crime Scene Awareness). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Before a SWAT team serves a high-risk warrant, the tactical medic prepares a medical threat assessment. This plan mainly covers:

   1. A. The suspect's criminal record and his known associates
   2. B. The legal grounds police have for the warrant
   3. C. Which officers will make entry and in what order
   4. D. Likely injuries, routes, and the nearest trauma center
   Show answer

   Answer: D. Likely injuries, routes, and the nearest trauma center

   The medical threat assessment anticipates injuries and hazards, names receiving hospitals and routes, and plans casualty evacuation. The criminal and legal details belong to the police planners.

2. Besides treating casualties, a key duty of a tactical EMS medic during a long standoff is to:

   1. A. Negotiate with the barricaded suspect by telephone
   2. B. Monitor team members for heat illness and fatigue
   3. C. Decide when officers may enter the building
   4. D. Interview witnesses for the police report
   Show answer

   Answer: B. Monitor team members for heat illness and fatigue

   Tactical medics provide preventive care for the team, such as hydration, rest, and monitoring for heat or cold stress during prolonged operations. Negotiation and tactical decisions are police roles.

3. During a tactical operation, a wounded officer is lying in the open where the suspect can still fire. The tactical medic cannot safely reach him. Remote assessment means:

   1. A. Calling his family on the radio
   2. B. Waiting until the suspect has been arrested
   3. C. Checking him by voice or sight from cover
   4. D. Asking dispatch to read his medical history
   Show answer

   Answer: C. Checking him by voice or sight from cover

   Remote assessment uses voice, binoculars, or observation from cover to judge whether a casualty is alive, conscious, and bleeding, and to coach self-aid such as applying his own tourniquet. It lets care begin without exposing the medic.

4. A tactical medic must move with the entry team without being noticed. Light and noise discipline means the medic should:

   1. A. Avoid needless light, sound, and radio chatter
   2. B. Use red light freely, since it cannot be seen
   3. C. Mute the alarms but keep making frequent radio checks
   4. D. Leave the monitor alarms on for patient safety
   Show answer

   Answer: A. Avoid needless light, sound, and radio chatter

   Lights, rattling gear, and loud voices can give away the team's position. Tactical medics carry quiet, compact kits and use light and sound only when needed. Red light is harder to see from a distance than white but is still visible, and frequent radio checks add the chatter that discipline is meant to cut.

5. Before a planned operation, a tactical medic keeps a confidential record for each team member that lists:

   1. A. Arrest history and disciplinary records
   2. B. Counseling notes and therapy history
   3. C. Fitness test results and shift schedule
   4. D. Allergies, medications, and vaccines
   Show answer

   Answer: D. Allergies, medications, and vaccines

   A confidential medical profile of each officer's conditions, medications, allergies, and immunizations (such as tetanus and hepatitis B) lets the medic treat team members quickly and safely, and it travels with an injured member to the hospital. Arrest and disciplinary records are personnel matters. Counseling notes are private and are not needed for emergency care, and fitness results and shift schedules do not guide treatment of an injured member.

6. At a crime scene, the responsibilities of police and EMS are best divided so that:

   1. A. EMS controls the scene until the patient has been removed
   2. B. Police decide which medical treatments are given
   3. C. Police control the scene and EMS directs patient care
   4. D. Whoever arrives first controls everything there
   Show answer

   Answer: C. Police control the scene and EMS directs patient care

   Law enforcement is responsible for the scene, its safety, and the investigation, while EMS is responsible for medical care. Working out conflicts calmly and quickly keeps both missions on track.

7. Police on scene say the shooter may still be in the house and ask you to wait outside. You can see the victim lying in the yard. You should:

   1. A. Run in to grab the victim while police watch
   2. B. Wait until police say it is safe to move in
   3. C. Send one paramedic in alone to assess him
   4. D. Pull the ambulance up onto the lawn beside him
   Show answer

   Answer: B. Wait until police say it is safe to move in

   Police are best placed to judge an active threat. Entering against their advice risks adding a casualty; be ready with a plan to move quickly the moment police allow access.

8. Officers bring you a man they just arrested and ask you to 'medically clear' him for jail. He was in a fight and smells of alcohol. The best response is to:

   1. A. Assess him and transport if any concern remains
   2. B. Sign a statement saying he is fit for jail
   3. C. Decline to look at him, since he is in police custody
   4. D. Clear him if he can say his name and the date
   Show answer

   Answer: A. Assess him and transport if any concern remains

   Prehospital assessment cannot rule out problems such as head injury or intoxication-related emergencies. Assess him, document findings, and transport for evaluation when there is any concern; do not sign off as if you had medically cleared him.

9. A patient in custody is handcuffed to your stretcher when he has a generalized seizure. You should:

   1. A. Leave the cuffs on until the seizure ends
   2. B. Tighten the cuffs so he cannot hit his arm
   3. C. Have the officer remove the cuffs at once
   4. D. Cut the stretcher strap to free his arm
   Show answer

   Answer: C. Have the officer remove the cuffs at once

   Handcuffs during a seizure can cause fractures, nerve injury, and skin damage, and they keep you from positioning and protecting the airway. The officer, who holds the key, should remove them.

10. Police struck a man in the chest with a beanbag round. He is alert, with pain and a bruise over his ribs. You should:

    1. A. Release him, since the round is less lethal
    2. B. Apply a cold pack and clear him for jail
    3. C. Let police decide whether he needs care
    4. D. Assess for chest injury and transport
    Show answer

    Answer: D. Assess for chest injury and transport

    Kinetic impact rounds such as beanbags and rubber or foam projectiles can fracture ribs, cause pulmonary or cardiac contusion, and even penetrate the skin, and deaths have been reported; assess him as a blunt chest trauma patient and transport. 'Less lethal' does not mean harmless. A cold pack and clearance for jail can miss internal injury. Medical decisions belong to EMS, not to the officers.

11. A man in custody quietly tells you he will hang himself in his cell tonight. He asks you not to tell anyone. You should:

    1. A. Keep it private, as HIPAA requires
    2. B. Tell the officer; transport him
    3. C. Tell no one unless he says it again
    4. D. Write it in your report and clear him
    Show answer

    Answer: B. Tell the officer; transport him

    A stated plan for suicide is a serious, imminent threat. HIPAA permits disclosure to people able to prevent a serious and imminent threat to a person's safety and to a correctional institution when needed for an inmate's health and safety, so tell the officer, keep him under watch, and transport for evaluation. HIPAA does not require silence here. Waiting for him to repeat it, or documenting it without acting, leaves a high-risk patient alone in a cell.

12. Police used a conducted electrical weapon on a man. One probe is lodged in his eyelid and one in his thigh. You should:

    1. A. Leave the eyelid probe in for removal at the ED
    2. B. Pull both probes out at once with firm traction
    3. C. Cut the eyelid probe flush with the skin first
    4. D. Push the eyelid probe through and out the skin
    Show answer

    Answer: A. Leave the eyelid probe in for removal at the ED

    Probes in the eye or eyelid, face, neck, genitals, or breast should be stabilized and removed in the hospital. Probes in other areas may be removed per protocol and handled as sharps, since police may also keep them as evidence.

13. A man who was struck by a conducted electrical weapon fell face-first onto concrete. He is now calm. Besides checking the probe sites, you should:

    1. A. Remove the probes and release him
    2. B. Clear him because he is now calm
    3. C. Assess for injuries from the fall
    4. D. Treat for a lightning-type injury
    Show answer

    Answer: C. Assess for injuries from the fall

    Falls after an electrical weapon can cause head, facial, dental, and spinal injuries, which may be more serious than the probe wounds. Also look for the cause of the original behavior, such as intoxication. Removing probes and releasing him skips the fall assessment. Being calm now does not rule out a head injury. A conducted electrical weapon delivers low-energy pulses, not a lightning-type injury.

14. A man who was arrested during a drug raid tells police he swallowed several small bags of drugs to hide them. He feels fine. You should:

    1. A. Release him to jail, as he has no symptoms now
    2. B. Transport him, since toxicity may develop later
    3. C. Induce vomiting to recover the bags at once
    4. D. Give activated charcoal and then release him
    Show answer

    Answer: B. Transport him, since toxicity may develop later

    Packets swallowed in a hurry (body stuffing) can leak or rupture, causing delayed and possibly fatal toxicity. Transport for observation; inducing vomiting is not recommended and may cause aspiration.

15. During transport, a prisoner complains of crushing chest pain and asks you to remove his restraints. The officer stepped out of the ambulance. You should:

    1. A. Keep restraints on until the officer is back
    2. B. Remove the restraints, since he may be dying
    3. C. Loosen the restraints just enough to be safe
    4. D. Let him sit up on the bench to breathe easier
    Show answer

    Answer: A. Keep restraints on until the officer is back

    Prisoners sometimes feign illness to escape. Continue care and monitoring, but changes to custody restraints should be made only with the officer present; then cuffs can be moved to allow care if needed.

16. Police bring an arrested man to your ambulance for transport. Before he is loaded, you should ask the officer to:

    1. A. Remove his handcuffs for the ride
    2. B. Follow in the patrol car instead of riding
    3. C. Sign your report as a witness to the arrest
    4. D. Search him for weapons
    Show answer

    Answer: D. Search him for weapons

    A patient in custody should be searched by police before entering the ambulance, and an officer with the handcuff key should ride along or follow as policy directs. Removing the cuffs is the officer's call, made only if care requires it. Having the officer follow in the patrol car leaves the crew alone with a prisoner. The officer's signature as a witness has no bearing on safety.

17. You find a bag of white powder in the pocket of a patient who is in police custody. You should:

    1. A. Throw it away so it does not ride in your ambulance
    2. B. Keep it with his belongings at the hospital
    3. C. Give it to the officer and note it in your report
    4. D. Test it on scene to see what drug it may be
    Show answer

    Answer: C. Give it to the officer and note it in your report

    Contraband found during care should be handed to law enforcement and documented, including when and where it was found. Discarding it may destroy evidence, and testing it is not an EMS role.

18. During a tactical callout, a suspect is shot by police and needs care. The tactical medic should:

    1. A. Treat the suspect once it is safe, like anyone else
    2. B. Treat the officers first, since the suspect caused it
    3. C. Wait until the suspect has been transported
    4. D. Wait for the police commander to request care
    Show answer

    Answer: A. Treat the suspect once it is safe, like anyone else

    The duty to give care applies to suspects, hostages, bystanders, and officers. Once the suspect is controlled and the area is safe, treat him by medical priority.

19. Police plan to test a shooting suspect's hands for gunshot residue and ask you not to clean them. He has only a small cut on one finger. You should:

    1. A. Scrub both hands so the small cut does not get infected
    2. B. Wipe his hands with alcohol before checking his BGL
    3. C. Refuse the request, since he is now your patient
    4. D. Leave his hands unwashed and tell police what you touch
    Show answer

    Answer: D. Leave his hands unwashed and tell police what you touch

    Gunshot residue is easily lost to washing or wiping. When care does not require it, honor the police request, cover the cut with a dry dressing, and tell officers about any contact; patient care still comes first if it ever conflicts.

20. The contents of a typical tactical medic's individual kit focus on:

    1. A. A cardiac monitor, IV pumps, and a full drug box
    2. B. Bleeding control, airway adjuncts, and chest seals
    3. C. Splints, a long backboard, and a rigid cervical collar
    4. D. Glucometers, nebulizers, and pediatric scales
    Show answer

    Answer: B. Bleeding control, airway adjuncts, and chest seals

    Tactical kits are light and built around the leading preventable causes of combat-type death: hemorrhage, airway obstruction, and tension pneumothorax. A monitor, pumps, and a drug box are bulky and stay at the casualty collection point or ambulance. Backboards and full spinal packaging are not carried by the individual medic and are rarely indicated for penetrating trauma. Glucometers, nebulizers, and scales serve routine medical calls, not the threats of a tactical operation.

21. A man handcuffed tightly for an hour says the back of his right hand and thumb are numb. His radial pulse is strong. You should:

    1. A. Ask the officer to loosen the cuffs
    2. B. Reassure him, since his pulse is present
    3. C. Cut the cuffs off with trauma shears
    4. D. Elevate the hand and recheck in 1 hour
    Show answer

    Answer: A. Ask the officer to loosen the cuffs

    Tight cuffs compress the superficial radial nerve at the wrist, causing numbness over the back of the hand and thumb (handcuff neuropathy) that can last for months. Have the officer, who holds the key, loosen or reapply the cuffs, then recheck and document. A strong pulse does not rule out nerve compression. Trauma shears will not cut steel cuffs, and removal is a custody decision. Waiting an hour prolongs the compression.

22. During a hostage standoff, the incident commander asks EMS to plan for possible casualties. The most useful EMS step is to:

    1. A. Send a crew to the house to check on hostages
    2. B. Call the hostage taker to ask about injuries
    3. C. Set up a care area in front of the building
    4. D. Set up triage, treatment, and transport areas
    Show answer

    Answer: D. Set up triage, treatment, and transport areas

    EMS preplans for casualties by setting up triage, treatment, and transport resources at a safe location coordinated with police command. Contact with the hostage taker is a police task.

23. Officers bring you a woman who was bitten on the forearm by a police dog during an arrest. The wound has deep punctures. You should:

    1. A. Clean it on scene and release her to jail
    2. B. Close the punctures with adhesive strips
    3. C. Control bleeding, dress it, and transport
    4. D. Wait for the officer to request her care
    Show answer

    Answer: C. Control bleeding, dress it, and transport

    Police dog bites can crush tissue and cause deep punctures that become infected. Control bleeding, dress the wound, check distal function, and transport. Cleaning and releasing her misses deep tissue injury and the need for wound care. Closing punctures traps bacteria. A patient in custody is owed care based on her injury, not on an officer's request.

24. A trained tactical medic is assigned to a SWAT team. During a high-risk entry, the medic is usually positioned:

    1. A. At the front, leading the team inside
    2. B. Behind the entry team, ready to treat
    3. C. Inside the command post the whole time
    4. D. At the hospital to receive casualties
    Show answer

    Answer: B. Behind the entry team, ready to treat

    Tactical medics usually follow the entry team so they can reach casualties quickly without being the first exposed. Leading entry is a police role, and a medic far from the action cannot give early care.

25. A man under arrest has a forehead laceration. He is alert, oriented, sober, and clearly understands the risks, but he refuses care. You should:

    1. A. Treat him anyway, since he is under arrest
    2. B. Let the officer consent to care on his behalf
    3. C. Respect the refusal and document it as usual
    4. D. Restrain him so you can dress the laceration
    Show answer

    Answer: C. Respect the refusal and document it as usual

    Being in custody does not remove a competent adult's right to refuse care, and the arresting officer cannot consent for him. Explain the risks, document his capacity and refusal, and tell the officer so custody staff can recheck him.