Trauma Systems, Field Triage, and the Golden Period Practice Questions

25 multiple-choice questions on Trauma systems, field triage, and the golden period 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. In the classic trimodal pattern of trauma deaths, the third peak occurs days to weeks after injury and is caused mainly by:

   1. A. Severe brain or spinal cord injury
   2. B. Sepsis and multiple organ failure
   3. C. Hemorrhage from a ruptured spleen
   4. D. Airway obstruction at the scene
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   Answer: B. Sepsis and multiple organ failure

   The first peak (seconds to minutes) is from unsurvivable brain, high spinal cord, heart, or great vessel injury; the second (minutes to hours) is mainly from hemorrhage that may be survivable, as in 01#2; the third (days to weeks) comes from infection, sepsis, and organ failure. Good early care, including fast hemorrhage control and avoiding hypoxia, reduces late deaths too. Airway obstruction and a ruptured spleen cause early deaths.

2. Trauma deaths have classically been described as trimodal. The second peak, within minutes to hours of injury, is most often due to:

   1. A. Hemorrhage that may be survivable
   2. B. Sepsis and multiple organ failure
   3. C. Brainstem laceration at impact
   4. D. Aortic transection at the scene
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   Answer: A. Hemorrhage that may be survivable

   The second peak is the one EMS and trauma systems can change with rapid hemorrhage control and surgery. Sepsis and organ failure cause the late third peak, days to weeks after injury.

3. Caroline prefers the term golden period over golden hour because:

   1. A. The window has been proven to be two hours
   2. B. The hour begins when EMS arrives on scene
   3. C. Research found the concept to be invalid
   4. D. The window of survival varies by injury
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   Answer: D. The window of survival varies by injury

   A patient with a torn aorta may have minutes while another may have several hours; the point is that time to definitive care matters. The hour was never a fixed physiological limit.

4. The platinum 10 minutes refers to:

   1. A. The time allowed to reach a Level I trauma center
   2. B. The interval between repeat vital sign checks
   3. C. Limiting on-scene time for critical trauma
   4. D. The time a tourniquet may safely remain in place
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   Answer: C. Limiting on-scene time for critical trauma

   For critically injured patients, on-scene time should be 10 minutes or less, with nonessential care done en route. It does not describe transport time, which depends on geography.

5. Which component of a trauma system has the greatest potential to reduce trauma deaths overall?

   1. A. Rehabilitation
   2. B. Air medical transport
   3. C. Injury prevention
   4. D. Trauma research
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   Answer: C. Injury prevention

   An injury that never happens needs no treatment, so prevention programs such as seat belt and helmet laws save the most lives. Air transport helps selected patients but does not reduce the number of injuries.

6. Trauma center levels are designated by state or regional authorities, while the American College of Surgeons:

   1. A. Verifies that a center meets its standards
   2. B. Funds the daily operation of trauma centers
   3. C. Licenses paramedics to transport to them
   4. D. Sets the scope of practice for EMS
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   Answer: A. Verifies that a center meets its standards

   ACS verification confirms resources and processes; designation is a governmental act. The ACS does not license EMS providers or fund hospitals.

7. A region's trauma system is described as inclusive. This means that:

   1. A. Only Level I centers receive injured patients
   2. B. Patients may choose any hospital they like
   3. C. Trauma care is offered only in large cities
   4. D. All hospitals have a defined trauma role
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   Answer: D. All hospitals have a defined trauma role

   In an inclusive trauma system every acute-care hospital takes part at the level it can support, from Level I centers to rural hospitals that stabilize and transfer, so most injured patients can be matched to an appropriate facility. An exclusive system relies only on the major trauma centers. Patient preference does not define the system, and inclusive systems are designed to reach rural areas.

8. A Level III trauma center is best described as a facility that:

   1. A. Has every pediatric subspecialty in house
   2. B. Can resuscitate and operate, then transfer
   3. C. Leads trauma research for the whole region
   4. D. Offers ATLS-type stabilization without surgery
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   Answer: B. Can resuscitate and operate, then transfer

   Level III centers provide prompt assessment, resuscitation, emergency surgery, and stabilization, with transfer agreements for the most complex patients. ATLS-type stabilization without routine surgical capability describes Level IV.

9. A Level IV trauma center is most often found in:

   1. A. A large urban university teaching hospital
   2. B. A free-standing children's specialty hospital
   3. C. A rural area far from larger centers
   4. D. A military combat support hospital
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   Answer: C. A rural area far from larger centers

   Level IV centers provide initial evaluation and stabilization before transfer in areas where no higher-level center is close. Urban teaching hospitals are typically Level I.

10. The 2021 National Guideline for the Field Triage of Injured Patients, used in the 9th edition, was developed by an expert panel led by the:

    1. A. American College of Surgeons COT
    2. B. National Highway Traffic Safety Admin
    3. C. American Heart Association
    4. D. National Registry of EMTs
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    Answer: A. American College of Surgeons COT

    The 2021 National Guideline for the Field Triage of Injured Patients was developed by a national expert panel convened by the American College of Surgeons (ACS) Committee on Trauma, replacing the 2011 CDC scheme; it was published in the trauma literature in 2022. The National Highway Traffic Safety Administration (NHTSA) funded the work through a cooperative agreement but did not lead the panel. The American Heart Association writes CPR and cardiovascular guidelines, not trauma triage criteria. The National Registry of EMTs certifies EMS clinicians and does not write field triage guidelines.

11. The 2021 field triage guideline sorts patients into which two main risk categories?

    1. A. Immediate, delayed, minor, and expectant
    2. B. Red (high risk) and yellow (moderate risk)
    3. C. Priority 1, 2, and 3 based on vital signs
    4. D. Green (stable) and black (unsalvageable)
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    Answer: B. Red (high risk) and yellow (moderate risk)

    Red criteria point to the highest-level trauma center available; yellow criteria point to a trauma center, which need not be the highest level. Immediate, delayed, minor, and expectant are mass-casualty triage categories.

12. Under the 2021 field triage guideline, a patient who meets any red criterion should be transported to:

    1. A. The closest emergency department, of any type
    2. B. Any trauma center within the regional system
    3. C. The hospital that the patient asks to go to
    4. D. The highest-level trauma center available
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    Answer: D. The highest-level trauma center available

    Red criteria identify patients at high risk of serious injury who need the most capable center within the regional system. Any trauma center is the yellow-criteria destination.

13. After a fall, a 40-year-old man is confused. Which mental status finding, if present, would meet a red criterion in the 2021 field triage guideline?

    1. A. Total GCS of 14 after a brief syncopal episode
    2. B. Amnesia for the event with a normal exam
    3. C. Unable to follow commands (motor GCS under 6)
    4. D. Anxiety and repeated questioning
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    Answer: C. Unable to follow commands (motor GCS under 6)

    The 2021 guideline replaced the total GCS of 13 or less with the simpler inability to follow commands. A GCS of 14 alone does not meet a red criterion.

14. A 50-year-old man has chest wall pain after a crash. Which respiratory finding would meet a red criterion in the 2021 field triage guideline?

    1. A. Respiratory rate of 24 breaths/min
    2. B. SpO2 of 94% on room air
    3. C. Shallow breathing with pleuritic pain
    4. D. Room-air SpO2 below 90%
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    Answer: D. Room-air SpO2 below 90%

    Red respiratory criteria are a rate under 10 or over 29, respiratory distress or need for support, or room-air SpO2 under 90%. A rate of 24 is within the accepted range.

15. A 72-year-old man fell down several stairs. BP 104/68 mmHg, pulse 88/min. He is alert. Under the 2021 field triage guideline he:

    1. A. Meets no criteria because SBP exceeds 90
    2. B. Meets a red criterion for his age
    3. C. Meets the yellow fall-from-stairs criterion
    4. D. Needs a trauma center if he takes aspirin
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    Answer: B. Meets a red criterion for his age

    For patients 65 and older, an SBP under 110 mmHg is a red criterion because older adults are often hypotensive relative to their usual pressure. The SBP under 90 cutoff applies to ages 10 to 64.

16. A 34-year-old woman has a BP of 96/60 mmHg and a pulse of 118/min after a crash. Under the 2021 guideline she meets a red criterion because:

    1. A. Her heart rate is greater than her SBP
    2. B. Her systolic pressure is under 100 mmHg
    3. C. Her pulse is faster than 100 beats/min
    4. D. Her diastolic pressure is under 65 mmHg
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    Answer: A. Her heart rate is greater than her SBP

    For ages 10 to 64 the red criteria are SBP under 90 or heart rate greater than SBP, a shock-index-style marker of occult shock. Tachycardia alone over 100 is not a criterion.

17. For a 4-year-old trauma patient, the 2021 field triage guideline treats an SBP below what value as a red criterion?

    1. A. 70 mmHg
    2. B. 90 mmHg
    3. C. 100 mmHg
    4. D. 78 mmHg
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    Answer: D. 78 mmHg

    For ages 0 to 9 the threshold is 70 plus twice the age in years, so 70 + 8 = 78 mmHg. A flat 70 mmHg is the threshold for infants, not a 4-year-old.

18. You are assessing several crash victims. Which injury pattern meets a red criterion in the 2021 field triage guideline?

    1. A. Isolated closed fracture of the distal radius bone
    2. B. Single rib fracture with clear, equal breath sounds
    3. C. Suspected fracture of two or more proximal long bones
    4. D. Laceration to the forearm controlled by pressure
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    Answer: C. Suspected fracture of two or more proximal long bones

    Two or more proximal long-bone fractures signal high energy and large blood loss. An isolated distal fracture or a single rib fracture does not meet a red criterion.

19. Under the 2021 guideline, active bleeding meets a red criterion when it:

    1. A. Requires a tourniquet or wound packing
    2. B. Soaks through a single gauze dressing
    3. C. Comes from a scalp laceration of any size
    4. D. Stops with 5 minutes of direct pressure
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    Answer: A. Requires a tourniquet or wound packing

    Bleeding that needs a tourniquet or packing with continuous pressure is new as a red criterion in 2021. Bleeding controlled with simple direct pressure does not qualify.

20. You arrive at a two-car crash. Which finding is a yellow mechanism criterion in the 2021 guideline?

    1. A. Airbag deployment in a minor fender-bender crash
    2. B. Intrusion over 12 inches at an occupant site
    3. C. Rear impact while stopped at a traffic light
    4. D. Vehicle towed from the scene after the crash
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    Answer: B. Intrusion over 12 inches at an occupant site

    High-risk crash criteria include intrusion over 12 inches at an occupant site or over 18 inches at any site, ejection, death in the same compartment, and telemetry suggesting severe injury. Airbag deployment alone is not a criterion.

21. In the 2021 field triage guideline, a fall meets a yellow mechanism criterion when it is from a height greater than:

    1. A. 10 feet (3 m) for all ages
    2. B. 20 feet (6 m) for adults
    3. C. Two times the child's height
    4. D. 15 feet (4.5 m) for adults
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    Answer: A. 10 feet (3 m) for all ages

    The 2021 guideline simplified the fall criterion to more than 10 feet for every age group. The older scheme used 20 feet for adults and 10 feet or two to three times height for children.

22. A 30-year-old woman who is 26 weeks pregnant has minor bruising after a low-speed crash. Vitals are normal. Under the 2021 guideline you should:

    1. A. Release her since she meets no criteria
    2. B. Take her to a labor unit with no trauma care
    3. C. Transport her once vaginal bleeding begins
    4. D. Consider transport to a trauma center
    Show answer

    Answer: D. Consider transport to a trauma center

    Pregnancy over 20 weeks is a yellow EMS judgment criterion, because maternal compensation can hide injury to the mother and fetus. Waiting for vaginal bleeding misses placental abruption that is still concealed.

23. Which patient factor appears as an EMS judgment (yellow) criterion in the 2021 field triage guideline?

    1. A. Age over 45 years
    2. B. History of hypertension
    3. C. Anticoagulant use
    4. D. Use of a seat belt
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    Answer: C. Anticoagulant use

    Anticoagulants raise the risk of intracranial and other hemorrhage after even minor trauma. Age over 45 and hypertension are not triage criteria.

24. When the 2021 guideline's criteria are not met but the paramedic is still concerned about serious injury, the guideline advises:

    1. A. Ask medical control to approve refusal
    2. B. Transport to a trauma center
    3. C. Recheck vital signs before deciding
    4. D. Transport to the nearest clinic
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    Answer: B. Transport to a trauma center

    The guideline closes with the instruction that if you are concerned, take the patient to a trauma center. Overtriage is acceptable to avoid missing serious injury, while undertriage harms patients.

25. Undertriage in a trauma system means:

    1. A. A minor injury is transported to a Level I center
    2. B. A seriously injured patient goes to a lesser center
    3. C. Mass-casualty triage tags are applied too early
    4. D. A patient is flown when ground transport was faster
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    Answer: B. A seriously injured patient goes to a lesser center

    Undertriage increases preventable death and is the error systems work hardest to avoid; the ACS target is under 5%. Sending minor injuries to a Level I center is overtriage, which wastes resources but is less dangerous.