Transport Decisions and Specialty Care Practice Questions

35 multiple-choice questions on Transport decisions and specialty care for paramedic and EMT students, from Chapter 1 (EMS Systems). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

35 practice questions

1. The decision to transport with lights and sirens should be based on:

   1. A. Whether the time saved changes outcome
   2. B. Crew preference and years of experience
   3. C. Traffic conditions along the route alone
   4. D. Agency tradition for that specific call type
   Show answer

   Answer: A. Whether the time saved changes outcome

   Base it on the patient's condition and whether the time saved changes the outcome. Lights and sirens typically save only a few minutes at real risk.

2. Air medical transport is most appropriate when:

   1. A. The closest ground unit is busy
   2. B. Weather is clear and a pilot is available
   3. C. The patient or family requests it
   4. D. Critical patient with long ground time
   Show answer

   Answer: D. Critical patient with long ground time

   Air transport fits a critical patient when ground time to the right facility is too long or the scene is hard to reach. It is a clinical decision balanced against real risks and cost.

3. A typical helicopter landing zone should be:

   1. A. About 100 by 100 feet, level, clear of wires
   2. B. On a downhill slope from the scene
   3. C. Marked by road flares at each corner
   4. D. Any open parking lot near the scene
   Show answer

   Answer: A. About 100 by 100 feet, level, clear of wires

   It should be about 100 by 100 feet, level, and clear of wires, poles, and loose debris. Crews must also keep bystanders back and approach only when signaled.

4. Which is a limitation of air medical transport?

   1. A. Weather, weight limits, and cabin space
   2. B. It requires a physician on board
   3. C. It is always slower than ground
   4. D. It cannot carry cardiac monitors
   Show answer

   Answer: A. Weather, weight limits, and cabin space

   Bad weather turns down a large share of requests.

5. Trauma center designation levels indicate:

   1. A. The size of the hospital's emergency department
   2. B. Capabilities, with Level I the highest
   3. C. The hospital's distance from the city
   4. D. The number of staffed inpatient beds
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   Answer: B. Capabilities, with Level I the highest

   Levels reflect the resources and capabilities available, with Level I the most comprehensive. Level I centers have surgical specialists and research and teaching programs.

6. The right destination for a patient is:

   1. A. Always the nearest designated trauma center
   2. B. Whichever hospital the family prefers most
   3. C. Always the closest hospital, regardless of need
   4. D. Closest appropriate facility per protocol
   Show answer

   Answer: D. Closest appropriate facility per protocol

   It is the closest appropriate facility for that patient's condition, following local protocol. Stroke, STEMI, burn, and pediatric patients often need a specific center.

7. When a competent adult refuses transport, the paramedic should:

   1. A. Leave as soon as the patient declines care
   2. B. Explain risks, persuade, and document
   3. C. Have a family member sign on their behalf
   4. D. Transport the patient anyway for safety
   Show answer

   Answer: B. Explain risks, persuade, and document

   Explain the risks in plain language, try to persuade, involve medical control as needed, and document thoroughly. Refusals are one of the highest-liability calls in EMS.

8. An interfacility transfer may require a paramedic to:

   1. A. Reduce the level of care the patient gets
   2. B. Manage equipment beyond routine practice
   3. C. Transport without receiving a verbal report
   4. D. Skip the usual documentation requirements
   Show answer

   Answer: B. Manage equipment beyond routine practice

   Interfacility work may involve equipment and infusions beyond routine 911 practice, which may need extra training. Ventilators, pumps, and blood products are common.

9. The choice between a BLS and an ALS unit for transport should be based on:

   1. A. What the receiving hospital staff prefers
   2. B. Which crew is closest to the sending facility
   3. C. Patient acuity and likely interventions
   4. D. Which level of service bills at a higher rate
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   Answer: C. Patient acuity and likely interventions

   Base it on the patient's acuity and the interventions that may be needed en route. A patient who may deteriorate belongs with ALS.

10. When a hospital is on diversion, EMS should:

    1. A. Go to the closest open hospital, whatever its capability
    2. B. Follow protocol to the next appropriate facility
    3. C. Ask dispatch to override the diversion
    4. D. Transport there anyway in every case
    Show answer

    Answer: B. Follow protocol to the next appropriate facility

    Follow local protocol and go to the next appropriate facility, unless the patient is unstable and needs immediate care. An unstable patient goes to the closest facility that can stabilize them. Dispatch cannot override a hospital's diversion status, and the nearest open hospital may lack the care this patient needs.

11. The decision to transport a patient is based primarily on:

    1. A. Clinical need and patient wishes
    2. B. Hospital capacity that day
    3. C. Crew workload and fatigue
    4. D. Patient preference alone
    Show answer

    Answer: A. Clinical need and patient wishes

    The decision rests on clinical need, with the patient's wishes and system protocols considered. Competent patients may refuse.

12. Nonemergency transport is appropriate when:

    1. A. The receiving hospital is far from the scene
    2. B. The patient is unstable or deteriorating
    3. C. Time saved would not change outcome
    4. D. The family wants to arrive as fast as possible
    Show answer

    Answer: C. Time saved would not change outcome

    Most transports are nonemergency.

13. Which patient most clearly justifies transport with lights and siren?

    1. A. A crash victim whose airway you cannot maintain
    2. B. An open ankle fracture with good distal pulses
    3. C. Chest pain now resolved, with a normal 12-lead
    4. D. A stable hip fracture with severe pain
    Show answer

    Answer: A. A crash victim whose airway you cannot maintain

    Lights and siren save only a few minutes and raise the crash risk for the crew, the patient, and the public. Use them only when those minutes are likely to change the outcome, such as an airway you cannot control. An open fracture with good pulses, resolved chest pain with a normal ECG, and a painful but stable hip fracture all need prompt care, but not an emergency-mode transport.

14. Choosing a facility farther away is justified when:

    1. A. The patient needs care the closer one lacks
    2. B. The closer emergency department is very busy
    3. C. The crew is more familiar with it
    4. D. The family prefers the other hospital
    Show answer

    Answer: A. The patient needs care the closer one lacks

    It is justified when the patient requires capability the closer facility lacks and is stable enough for the longer trip. An unstable airway may force the closer facility.

15. Bypassing a closer hospital for a trauma center is based on:

    1. A. The patient's request
    2. B. The patient's insurance coverage
    3. C. National field triage criteria
    4. D. The crew's judgment alone
    Show answer

    Answer: C. National field triage criteria

    Field triage criteria include physiologic, anatomic, mechanism, and special considerations. National guidelines define these criteria.

16. Under the 2021 National Guideline for the Field Triage of Injured Patients, which finding in an injured adult meets a high-risk (red) criterion for transport to the highest-level trauma center?

    1. A. Systolic BP of 104 mm Hg in a 72-year-old
    2. B. Respiratory rate of 26 breaths/min
    3. C. Heart rate of 112 with a systolic BP of 130
    4. D. GCS of 14 because of confusion about the date
    Show answer

    Answer: A. Systolic BP of 104 mm Hg in a 72-year-old

    The 2021 guideline lowered the bar for older adults: at age 65 or older, a systolic BP under 110 mm Hg is a red criterion (under 90 for ages 10 to 64), as is a heart rate higher than the systolic BP at any adult age. A respiratory rate of 26 is inside the 10 to 29 range. A heart rate of 112 is still below the systolic pressure of 130. The old 'GCS 13 or less' cutoff was replaced with 'unable to follow commands (motor GCS under 6),' so a confused patient with GCS 14 does not meet a red criterion.

17. Which anatomic criterion suggests trauma center transport?

    1. A. Bruising over the forearm after a fall
    2. B. Penetrating injury to head, neck, or torso
    3. C. Superficial abrasions across the chest wall
    4. D. Isolated ankle sprain with marked swelling
    Show answer

    Answer: B. Penetrating injury to head, neck, or torso

    Penetrating injury to the head, neck, torso, or proximal extremities qualifies. So does an unstable chest wall or two or more proximal long bone fractures.

18. Special considerations in trauma triage include:

    1. A. Insurance status and payer type
    2. B. Patient age as the only factor
    3. C. Age, anticoagulants, burns, pregnancy
    4. D. Transport distance as the only factor
    Show answer

    Answer: C. Age, anticoagulants, burns, pregnancy

    Special considerations include age, anticoagulant use, burns, pregnancy, and provider judgment. Older patients are frequently undertriaged.

19. Undertriage refers to:

    1. A. Seriously injured not sent to a center
    2. B. Overusing air medical transport for trauma
    3. C. Documenting more injuries than are present
    4. D. Sending too many patients to trauma centers
    Show answer

    Answer: A. Seriously injured not sent to a center

    Undertriage is failing to transport a seriously injured patient to an appropriate center. It carries mortality risk.

20. Overtriage is tolerated to some degree because:

    1. A. Missing serious injury is worse
    2. B. It improves EMS response times
    3. C. It is required by federal law
    4. D. It reduces overall system costs
    Show answer

    Answer: A. Missing serious injury is worse

    Missing a serious injury is worse than sending some less-injured patients to a trauma center. Systems set acceptable rates.

21. Which patient is the best candidate for air medical transport?

    1. A. A stable ankle fracture 60 minutes from the nearest hospital
    2. B. A patient in cardiac arrest with CPR in progress, 10 minutes from a hospital
    3. C. A hypotensive rollover patient 60 minutes by ground from a trauma center
    4. D. A stable chest pain patient 8 minutes by ground from a PCI center
    Show answer

    Answer: C. A hypotensive rollover patient 60 minutes by ground from a trauma center

    Air transport is worth its risk and cost when a critical, time-sensitive patient faces a long ground transport to the right facility. A hypotensive trauma patient an hour from a trauma center fits. A stable ankle fracture gains nothing from speed. CPR is hard to perform in a helicopter, and a hospital 10 minutes away is closer. A PCI center 8 minutes by ground is faster than launching an aircraft.

22. Requesting a helicopter early is important because:

    1. A. It guarantees the aircraft will be available
    2. B. It shortens the actual flight time
    3. C. It reduces the ground crew's workload
    4. D. Launch time can overlap patient care
    Show answer

    Answer: D. Launch time can overlap patient care

    Activation, flight, and landing take time that should overlap with patient care. Cancel if the patient improves or ground transport is faster. An early request does not guarantee an aircraft; weather and other missions can still prevent a launch.

23. You are setting up a night landing zone in a field for an incoming helicopter. Which hazard is most important to report to the flight crew?

    1. A. A fire engine parked well outside the zone
    2. B. Power lines along one edge of the field
    3. C. Wet grass across the landing area
    4. D. Spectators held back behind a wide perimeter
    Show answer

    Answer: B. Power lines along one edge of the field

    Wires and poles are hard for pilots to see, especially at night, and wire strikes are a major cause of helicopter EMS crashes. Report them and mark them where possible. A fire engine parked outside the zone and spectators behind a perimeter are already where they belong. Wet grass is worth mentioning but does not threaten the aircraft the way wires do.

24. Approaching a helicopter should be done:

    1. A. From the uphill side of a slope
    2. B. Whenever the patient is ready
    3. C. As soon as the skids touch the ground
    4. D. From the front, when signaled
    Show answer

    Answer: D. From the front, when signaled

    Approach from the front, in view of the pilot, and only when signaled. Never approach until crew members direct you. On a slope the rotor disk is closest to the ground on the uphill side, and the rotors are still turning at touchdown, so wait for the crew's signal.

25. The air medical service declines your request for a critical trauma patient because the weather is below its flight minimums. What is the best response?

    1. A. Call other flight services until one agrees to fly the patient
    2. B. Start ground transport to the most appropriate facility now
    3. C. Wait on scene with the patient until the weather improves
    4. D. Drive to the nearest clinic and request a helicopter from there
    Show answer

    Answer: B. Start ground transport to the most appropriate facility now

    A weather turndown is a safety decision. Calling other services without telling them it was already turned down ('helicopter shopping') has contributed to fatal crashes. The patient's best option is to start ground transport to the right facility now. Waiting on scene delays definitive care for a time-critical patient. Diverting to a clinic adds a stop and does not change the weather.

26. A patient with a suspected stroke should be transported to:

    1. A. The nearest Level I or II trauma center
    2. B. Any hospital that has a working CT scanner
    3. C. A stroke-capable facility per protocol
    4. D. The closest hospital regardless of capability
    Show answer

    Answer: C. A stroke-capable facility per protocol

    Transport to a facility capable of stroke care within the protocol's time window. Document the last known well time.

27. A STEMI patient benefits most from transport to:

    1. A. A PCI-capable facility in guideline time
    2. B. The closest facility in every single case
    3. C. The nearest emergency department of any type
    4. D. The nearest Level I trauma center available
    Show answer

    Answer: A. A PCI-capable facility in guideline time

    Transport to a facility capable of percutaneous coronary intervention when reachable within guideline times. Prehospital ECG transmission activates the team early.

28. A patient with severe burns may require:

    1. A. Care at the local community hospital only
    2. B. Outpatient wound care after field cooling
    3. C. A burn center, per established criteria
    4. D. A trauma center for every burn patient
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    Answer: C. A burn center, per established criteria

    Criteria consider depth, area, location, and age.

29. Pediatric patients should ideally be transported to:

    1. A. The closest facility in every single case
    2. B. A pediatric-capable facility when feasible
    3. C. Any trauma center in the surrounding region
    4. D. A large adult facility with a busy ED
    Show answer

    Answer: B. A pediatric-capable facility when feasible

    Transport to a facility with pediatric capability when the condition and distance allow. Some regions designate pediatric receiving facilities.

30. An obstetric patient in active labor with imminent delivery should:

    1. A. Be transported quickly regardless of stage
    2. B. Be asked to resist pushing until arrival
    3. C. Deliver on scene if birth is imminent
    4. D. Always go to a specialty obstetric center
    Show answer

    Answer: C. Deliver on scene if birth is imminent

    Assess for imminent delivery, and deliver on scene if birth is imminent. Delivering in a moving ambulance is riskier than a controlled scene delivery.

31. Which factor should NOT influence destination decisions?

    1. A. Insurance or ability to pay
    2. B. Expected transport time
    3. C. The patient's condition
    4. D. The facility's capabilities
    Show answer

    Answer: A. Insurance or ability to pay

    It is also prohibited by law and policy.

32. Diversion means a hospital:

    1. A. Has permanently closed its emergency department
    2. B. Refuses all patients, including walk-ins
    3. C. Is undergoing construction in its trauma bays
    4. D. Asked EMS to go elsewhere due to capacity
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    Answer: D. Asked EMS to go elsewhere due to capacity

    Diversion means the hospital has asked ambulances to go elsewhere because of capacity or capability issues. Unstable patients still go to the closest appropriate facility.

33. A patient with capacity who requests a specific hospital should:

    1. A. Generally be honored if appropriate
    2. B. Be taken to the closest facility instead
    3. C. Always be taken there regardless of need
    4. D. Have the request refused by the crew
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    Answer: A. Generally be honored if appropriate

    Generally honor the preference if the facility is appropriate and within policy. Explain when their choice is not clinically appropriate.

34. Interfacility transfer requires the transporting crew to:

    1. A. Verify they can manage the patient's needs
    2. B. Transport without any written transfer report
    3. C. Rely entirely on the sending staff's assessment
    4. D. Accept the patient without reviewing the chart
    Show answer

    Answer: A. Verify they can manage the patient's needs

    Verify the crew can manage the patient's equipment, medications, and anticipated needs. Escalate to a critical care crew when needed.

35. Documentation for an interfacility transfer should include:

    1. A. Reason, providers, care, and condition
    2. B. Nothing beyond what a standard 911 report needs
    3. C. The total transport time and mileage only
    4. D. The receiving facility's name and nothing else
    Show answer

    Answer: A. Reason, providers, care, and condition

    Include the reason for transfer, sending and receiving providers, care during transport, and patient condition. Records should travel with the patient.