Trauma Assessment, Scene Time, and Transport Decisions Practice Questions

25 multiple-choice questions on Trauma assessment, scene time, and transport decisions for paramedic and EMT students, from Chapter 30 (Trauma Systems and Mechanism of Injury). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Index of suspicion in trauma care means:

   1. A. Anticipating likely injuries from the mechanism
   2. B. Ranking injuries by what is visible on exam
   3. C. Doubting the patient's report of pain
   4. D. Grading injury severity from the first vital signs
   Show answer

   Answer: A. Anticipating likely injuries from the mechanism

   A high index of suspicion based on mechanism leads you to look for and treat injuries before they become obvious. It is a clinical tool, not a judgment of the patient's honesty. It is not limited to injuries you can see or to the first set of vital signs, which are often normal early.

2. In the primary survey of a trauma patient with major external bleeding, the first step after scene safety is to:

   1. A. Open the airway with a jaw-thrust maneuver
   2. B. Count the respiratory rate
   3. C. Apply a cervical collar
   4. D. Control the life-threatening hemorrhage
   Show answer

   Answer: D. Control the life-threatening hemorrhage

   Current trauma teaching uses XABCDE, putting exsanguinating hemorrhage first because a person can bleed to death faster than he will die of hypoxia. Airway follows immediately.

3. Which factor can mask signs of serious injury in a trauma patient?

   1. A. A history of well-controlled asthma
   2. B. Eating a large meal before the crash
   3. C. Alcohol or drug intoxication
   4. D. Wearing a seat belt
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   Answer: C. Alcohol or drug intoxication

   Intoxication blunts pain and alters mental status, so the exam becomes unreliable and mechanism carries more weight. A seat belt changes the injury pattern but does not hide signs, and controlled asthma or a recent meal does not blunt pain or alter mental status.

4. A patient with an obvious open tibia fracture denies any other pain after a high-speed crash. The fracture is best described as a:

   1. A. Mechanism of injury
   2. B. Distracting injury
   3. C. Primary survey finding
   4. D. Golden period injury
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   Answer: B. Distracting injury

   A painful, dramatic injury can draw the patient's and paramedic's attention from more lethal hidden injuries. Complete a full rapid trauma exam regardless.

5. Which procedure is generally appropriate to perform on scene for a critical trauma patient?

   1. A. Hemorrhage control and airway management
   2. B. Splinting of every minor fracture
   3. C. Starting two large-bore IV lines before moving
   4. D. A complete detailed head-to-toe exam
   Show answer

   Answer: A. Hemorrhage control and airway management

   Only life-saving interventions belong on scene; IV access, splinting, and the secondary assessment can be done en route. Starting IV lines before moving is a common cause of prolonged scene time.

6. You are 25 minutes by ground from a Level I trauma center and 10 minutes from a community hospital with no surgeon on call. The patient meets red criteria and is in shock. A helicopter would take 20 minutes to reach you. The best decision is usually to:

   1. A. Go to the community hospital first
   2. B. Transport by ground to the Level I center
   3. C. Wait on scene for the helicopter
   4. D. Stay on scene to start two IV lines
   Show answer

   Answer: B. Transport by ground to the Level I center

   Red criteria direct transport to the highest-level trauma center within the regional system, and 25 minutes by ground is well within typical bypass limits. A hospital with no surgeon cannot stop internal bleeding and adds a second transfer. Waiting 20 minutes for a helicopter plus flight time would not beat the ground transport time; air medical helps only when it meaningfully shortens time to definitive care. IV access belongs en route, not on scene. Regional protocols define bypass times and air activation rules, so follow them.

7. A critically injured driver is pinned and extrication will take about 20 minutes. While rescuers work, you should:

   1. A. Start care such as oxygen and IV access
   2. B. Wait to touch him until he is fully out
   3. C. Leave and return when the car is cut
   4. D. Apply a traction splint before anything
   Show answer

   Answer: A. Start care such as oxygen and IV access

   When extrication is prolonged, care should begin as soon as you can safely reach the patient: open and protect the airway, give oxygen, control bleeding, and start IV access if feasible, so that time in the vehicle is not wasted. Waiting or leaving delays life-saving care. Splinting a limb is not a priority over airway, breathing, and circulation.

8. A 45-year-old crash victim is pale and tachycardic, and his BP is falling. How often should you reassess his vital signs?

   1. A. Every 15 minutes
   2. B. Once during transport
   3. C. At least every 5 minutes
   4. D. On arrival at the hospital
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   Answer: C. At least every 5 minutes

   Unstable patients can deteriorate quickly, so reassess every 5 minutes and after each intervention. Every 15 minutes is the interval for stable patients.

9. For a crash victim with internal bleeding, the time window described by the golden period is counted from:

   1. A. The EMS arrival on scene
   2. B. Arrival at the trauma center
   3. C. The first set of vital signs
   4. D. The moment of injury
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   Answer: D. The moment of injury

   The golden period is the time from injury to definitive (usually surgical) care, so minutes lost before the 911 call, during response, and on scene all count against it; that is why scene time for critical patients is kept short. It does not start when EMS arrives, when vitals are first taken, or at hospital arrival.

10. When reporting to the trauma team, describing the mechanism of injury is important because it:

    1. A. Predicts the exact injuries the patient has
    2. B. Replaces the need for a physical exam
    3. C. Helps the team anticipate hidden injuries
    4. D. Sets the patient's final trauma score
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    Answer: C. Helps the team anticipate hidden injuries

    The trauma team cannot see the scene, so details such as intrusion, speed, and restraint use guide imaging and surgical decisions. The mechanism raises suspicion but cannot predict exact injuries, replace the exam, or set an injury score, which depends on findings made after diagnosis.

11. A 6-year-old struck by a car has a normal BP but a heart rate of 150/min. Children in hemorrhagic shock differ from adults because they:

    1. A. Become hypotensive early in shock
    2. B. Compensate well and then deteriorate suddenly
    3. C. Have a slower heart rate when they are bleeding
    4. D. Lose less blood from the same wound
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    Answer: B. Compensate well and then deteriorate suddenly

    Strong vascular tone keeps BP normal until a large volume is lost, then children crash rapidly. Hypotension in a child is therefore a very late, ominous sign.

12. When choosing a destination for an injured child, the 2021 guideline advises that children be:

    1. A. Taken to the nearest adult trauma center
    2. B. Taken to the hospital where their records are kept
    3. C. Transported with a parent riding along
    4. D. Sent preferentially to pediatric-capable centers
    Show answer

    Answer: D. Sent preferentially to pediatric-capable centers

    Pediatric-capable trauma centers have the equipment and specialists children need. Parents may ride along but their presence does not drive the destination.

13. A 32-year-old woman at 34 weeks of gestation was in a crash. She is supine on a backboard and becomes hypotensive. Your first action is to:

    1. A. Manually displace the uterus to the left
    2. B. Elevate her legs above her heart
    3. C. Give a 2-liter bolus of crystalloid solution
    4. D. Raise the head of the backboard
    Show answer

    Answer: A. Manually displace the uterus to the left

    In the supine position the gravid uterus compresses the vena cava and reduces venous return. Displacing it to the left, or tilting the board, often restores BP; fluids alone will not relieve the compression.

14. A 29-year-old woman at 32 weeks of gestation was in a crash. Why may she lose a large volume of blood before showing signs of shock?

    1. A. Her heart rate decreases late in pregnancy
    2. B. Pregnancy protects against bleeding
    3. C. Her blood volume increases in pregnancy
    4. D. The fetus supplies blood to the mother
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    Answer: C. Her blood volume increases in pregnancy

    Blood volume rises by up to about 50%, so she can lose 30% or more before vital signs change. The body shunts blood away from the uterus to keep her BP, so the fetus may be in distress first.

15. The best way to care for a fetus after maternal trauma is to:

    1. A. Resuscitate the mother aggressively
    2. B. Focus on the fetal heart rate first
    3. C. Deliver the baby on scene
    4. D. Place the mother in a prone position
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    Answer: A. Resuscitate the mother aggressively

    Fetal survival depends on maternal perfusion and oxygenation. Delivery on scene is not indicated for trauma unless birth is imminent.

16. A 45-year-old man weighing 180 kg (400 lb) was injured in a fall. His care presents special challenges because:

    1. A. Fat protects the organs from injury
    2. B. Airway management and assessment are harder
    3. C. His vital signs are more reliable than average
    4. D. He tolerates lying supine better
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    Answer: B. Airway management and assessment are harder

    Airway management and assessment are harder because excess soft tissue makes intubation, ventilation, IV access, and physical exam difficult, and a properly sized BP cuff is needed. Obesity does not protect against organ injury. His vital signs are less reliable, not more, because cuff size and body habitus distort readings. Lying supine is tolerated worse, because the abdominal mass pushes on the diaphragm and reduces ventilation.

17. When reporting a crash to the trauma team, a photo of severe vehicle damage (where policy allows) helps mainly by:

    1. A. Proving which driver was at fault
    2. B. Replacing the need for a full exam later
    3. C. Documenting the vehicle's insurance
    4. D. Showing how much energy was involved
    Show answer

    Answer: D. Showing how much energy was involved

    Images of intrusion, a bent steering wheel, or a starred windshield convey the forces involved and help the team anticipate hidden injuries, much like the verbal mechanism report. Fault is a police and legal matter, a photo never replaces the patient assessment, and insurance details are irrelevant to care. Follow your agency's privacy policy.

18. A trauma patient's GCS is eye opening to pain, inappropriate words, and withdrawal from pain. His GCS score is:

    1. A. 7
    2. B. 8
    3. C. 9
    4. D. 10
    Show answer

    Answer: C. 9

    Eyes to pain is 2, inappropriate words is 3, and withdrawal is 4, totaling 9. Withdrawal is 4 and abnormal flexion is 3, a common source of error.

19. The Revised Trauma Score uses which parameters?

    1. A. Pulse, temperature, and oxygen saturation
    2. B. Age, weight, and blood glucose
    3. C. GCS, pulse, and capillary refill time
    4. D. GCS, systolic BP, and respiratory rate
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    Answer: D. GCS, systolic BP, and respiratory rate

    The RTS combines these three to predict survival and support triage. Capillary refill was used in an older trauma score but is not part of the RTS.

20. You arrive at a crash where a car hit a pole at high speed. The driver is sitting outside the vehicle, walking and talking. You should:

    1. A. Assess him fully based on the mechanism
    2. B. Obtain a refusal if his vitals are normal
    3. C. Assess the areas where he has pain
    4. D. Transport him if new symptoms appear
    Show answer

    Answer: A. Assess him fully based on the mechanism

    Walking at the scene does not exclude internal injury, especially with a high-energy mechanism. Explain the risks before any refusal and encourage transport. Normal first vital signs and waiting for symptoms both miss compensated internal injury.

21. Which statement about trauma scene time is most accurate?

    1. A. Longer scene times improve stabilization in shock
    2. B. Long scene times worsen outcomes in critical trauma
    3. C. Scene time matters mainly in rural areas
    4. D. Scene time is less important than the transport mode
    Show answer

    Answer: B. Long scene times worsen outcomes in critical trauma

    Many critical patients need surgery for definitive hemorrhage control, which cannot be done in the field. Field stabilization does not replace surgery.

22. A 30-year-old man has an unstable pelvis after a crash and no head injury. He is confused, his radial pulses are absent, and his BP is 70/40 mmHg. Your unit carries no blood products. Which fluid strategy is best en route?

    1. A. Large boluses until SBP is above 120 mmHg
    2. B. No fluid at all until arrival at the ED
    3. C. Small boluses until a radial pulse returns
    4. D. A vasopressor drip as the first treatment
    Show answer

    Answer: C. Small boluses until a radial pulse returns

    Permissive hypotension titrates small crystalloid boluses to a palpable radial pulse, improved mentation, or an SBP of about 80 to 90 mmHg, enough to perfuse vital organs without raising pressure so much that clots dislodge; blood products are preferred where available, along with a pelvic binder. Large boluses to a normal SBP dilute clotting factors, worsen hypothermia and acidosis, and increase bleeding. Withholding fluid can be reasonable when a radial pulse and mentation are maintained with a short transport, but this patient is pulseless at the wrist and confused. Vasopressors are not first-line for hemorrhagic shock, which needs volume and hemorrhage control. A head-injured patient would need a higher target (SBP at least 110 mmHg in most adults).

23. After a trauma patient is loaded into the ambulance, the next priority is to:

    1. A. Complete the paperwork before leaving the scene
    2. B. Begin transport and reassess en route
    3. C. Complete a detailed exam on scene
    4. D. Repeat the full scene size-up
    Show answer

    Answer: B. Begin transport and reassess en route

    Time to definitive care is the key outcome; secondary assessment and further treatment can be done during transport. Paperwork can be completed at the hospital.

24. A paramedic decides to take a patient with a concerning mechanism but normal vital signs to a trauma center. This is an example of:

    1. A. Undertriage of a minor patient
    2. B. A violation of the national triage guideline
    3. C. Abandonment of the patient
    4. D. Appropriate overtriage to reduce risk
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    Answer: D. Appropriate overtriage to reduce risk

    The field triage guideline accepts some overtriage to avoid missing serious injury. Undertriage, sending a seriously injured patient to an inadequate facility, is the more dangerous error.

25. An 85-year-old woman fell and has a hip fracture. She lives alone and takes a blood thinner. She asks you not to call her family. The most important clinical consideration is:

    1. A. Bleeding risk from the anticoagulant
    2. B. Her risk of fat embolism
    3. C. Her risk of a pressure injury
    4. D. Her ability to walk to the ambulance
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    Answer: A. Bleeding risk from the anticoagulant

    Anticoagulants increase bleeding risk from both the fracture and any head injury, and influence the destination. Her request about family is a privacy issue and does not change clinical care. Fat embolism and pressure injury are possible but far less immediate than bleeding, and a patient with a hip fracture should not walk to the ambulance.