PHTLS REVIEW TEST 2026/2027 | Prehospital Trauma
Life Support | Comprehensive Questions & Answers |
NAEMT 9th Edition | Pass Guaranteed - A+ Graded
Section 1: Trauma Triage & Decision Making (Questions 1-15)
Q1. A 24-year-old male involved in a high-speed MVC is found with GCS 14, HR 110,
BP 118/76, RR 22. Using the CDC Field Triage Decision Scheme Step 1 (Physiologic),
which criterion is met that would indicate transport to a trauma center?
A. GCS <13
B. Systolic blood pressure <90 mmHg
C. Respiratory rate <10 or >29 or need for ventilatory support
D. None of the above; this patient does not meet Step 1 physiologic criteria
[CORRECT]
Correct Answer: D
Rationale: Step 1 physiologic criteria require: GCS ≤13, SBP <90 mmHg, or RR <10
or >29 (or need for ventilatory support). This patient's GCS 14, SBP 118, and RR 22
do not meet any Step 1 criteria. However, Step 2 (Anatomic), Step 3 (Mechanism), or
Step 4 (Special considerations) may still apply.
Q2. A patient sustains a gunshot wound to the abdomen and is 45 minutes from the
nearest Level I trauma center by ground. A helicopter can arrive in 15 minutes with a
,10-minute flight time. Which transport decision is MOST appropriate per PHTLS
principles?
A. Scoop and run to the nearest community hospital for stabilization
B. Wait for helicopter on scene for direct transport to the Level I trauma center
[CORRECT]
C. Ground transport to the Level I center with advanced life support en route
D. Stay and play on scene for 30 minutes establishing IV access before transport
Correct Answer: B
Rationale: For penetrating torso trauma with hemodynamic instability risk,
minimizing scene time and transporting to the highest level trauma center is critical.
Helicopter transport reduces total time to definitive care (25 minutes vs 45 minutes
ground). "Scoop and run" (Option A) to a non-trauma center delays definitive care.
"Stay and play" (Option D) is contraindicated in penetrating trauma.
Q3. Which anatomic criterion from CDC Field Triage Step 2 would MANDATE
transport to the highest level trauma center available?
A. Isolated closed fracture of the radius
B. Flail chest [CORRECT]
C. Simple laceration requiring 5 sutures
D. Isolated nasal fracture with controlled epistaxis
Correct Answer: B
Rationale: Flail chest (two or more adjacent ribs fractured in two or more places)
represents severe thoracic trauma with potential for pulmonary contusion,
pneumothorax, and respiratory failure, meeting Step 2 anatomic criteria for trauma
center transport. Options A, C, and D are not Step 2 criteria and can be managed at
lower-level facilities.
,Q4. A 35-year-old motorcyclist is ejected at 60 mph and strikes a tree. He is
ambulatory at the scene with minor abrasions. Which mechanism of injury criterion
from Step 3 would indicate trauma center transport?
A. Fall from standing height
B. Ejection from vehicle [CORRECT]
C. Low-speed rear-end collision with airbag deployment
D. Bicycle fall with helmet use and no loss of consciousness
Correct Answer: B
Rationale: Ejection from a vehicle is a high-risk mechanism per CDC Step 3 criteria,
indicating significant energy transfer and potential for occult injuries. Even if the
patient appears stable, ejection mandates trauma center evaluation. Options A, C,
and D represent low-energy mechanisms not meeting Step 3 criteria.
Q5. A 78-year-old patient on warfarin falls from standing height and strikes their
head. They are on a beta-blocker and have a heart rate of 82 bpm. Which special
consideration from Step 4 applies?
A. Age >55 years and anticoagulant use [CORRECT]
B. Only age >65 years applies; anticoagulants are irrelevant
C. Beta-blocker use masks tachycardia but is not a triage criterion
D. Falls from standing height never meet trauma center criteria
Correct Answer: A
Rationale: Step 4 special considerations include: age >55 (some systems use >65),
anticoagulant/bleeding disorder use, burns, pregnancy, EMS provider judgment. Both
age and anticoagulant use independently indicate trauma center transport. Beta-
blockers (Option C) can mask shock but are not formal triage criteria. Option D is
incorrect—ground-level falls in elderly can cause significant intracranial hemorrhage.
, Q6. Which capability distinguishes a Level I trauma center from a Level II trauma
center?
A. 24-hour emergency department coverage by emergency physicians
B. Comprehensive neurosurgical capability and research requirement [CORRECT]
C. Basic radiology and laboratory services
D. Transfer agreements with Level I centers
Correct Answer: B
Rationale: Level I trauma centers require comprehensive neurosurgical services,
research programs, residency training, and continuous readiness for all injury types.
Level II centers provide definitive care but may not have research requirements or all
subspecialties immediately available. Options A, C, and D are capabilities shared by
or below Level II standards.
Q7. A patient meets Step 1 physiologic criteria (GCS 10, SBP 82). The nearest Level I
center is 90 minutes by ground. A Level III center is 15 minutes away. Which
transport decision is MOST appropriate?
A. Transport to Level III for stabilization and then transfer to Level I
B. Direct ground transport to Level I despite the distance
C. Activate aeromedical transport for direct transport to Level I [CORRECT]
D. Stay at scene for 20 minutes establishing two large-bore IVs before transport
Correct Answer: C
Rationale: For patients meeting physiologic criteria with prolonged ground transport
time, aeromedical transport reduces time to definitive care and provides advanced
interventions en route. Option A delays definitive care. Option B subjects the patient
to 90 minutes without trauma center capabilities. Option D violates "scoop and run"
principles for unstable trauma.
Life Support | Comprehensive Questions & Answers |
NAEMT 9th Edition | Pass Guaranteed - A+ Graded
Section 1: Trauma Triage & Decision Making (Questions 1-15)
Q1. A 24-year-old male involved in a high-speed MVC is found with GCS 14, HR 110,
BP 118/76, RR 22. Using the CDC Field Triage Decision Scheme Step 1 (Physiologic),
which criterion is met that would indicate transport to a trauma center?
A. GCS <13
B. Systolic blood pressure <90 mmHg
C. Respiratory rate <10 or >29 or need for ventilatory support
D. None of the above; this patient does not meet Step 1 physiologic criteria
[CORRECT]
Correct Answer: D
Rationale: Step 1 physiologic criteria require: GCS ≤13, SBP <90 mmHg, or RR <10
or >29 (or need for ventilatory support). This patient's GCS 14, SBP 118, and RR 22
do not meet any Step 1 criteria. However, Step 2 (Anatomic), Step 3 (Mechanism), or
Step 4 (Special considerations) may still apply.
Q2. A patient sustains a gunshot wound to the abdomen and is 45 minutes from the
nearest Level I trauma center by ground. A helicopter can arrive in 15 minutes with a
,10-minute flight time. Which transport decision is MOST appropriate per PHTLS
principles?
A. Scoop and run to the nearest community hospital for stabilization
B. Wait for helicopter on scene for direct transport to the Level I trauma center
[CORRECT]
C. Ground transport to the Level I center with advanced life support en route
D. Stay and play on scene for 30 minutes establishing IV access before transport
Correct Answer: B
Rationale: For penetrating torso trauma with hemodynamic instability risk,
minimizing scene time and transporting to the highest level trauma center is critical.
Helicopter transport reduces total time to definitive care (25 minutes vs 45 minutes
ground). "Scoop and run" (Option A) to a non-trauma center delays definitive care.
"Stay and play" (Option D) is contraindicated in penetrating trauma.
Q3. Which anatomic criterion from CDC Field Triage Step 2 would MANDATE
transport to the highest level trauma center available?
A. Isolated closed fracture of the radius
B. Flail chest [CORRECT]
C. Simple laceration requiring 5 sutures
D. Isolated nasal fracture with controlled epistaxis
Correct Answer: B
Rationale: Flail chest (two or more adjacent ribs fractured in two or more places)
represents severe thoracic trauma with potential for pulmonary contusion,
pneumothorax, and respiratory failure, meeting Step 2 anatomic criteria for trauma
center transport. Options A, C, and D are not Step 2 criteria and can be managed at
lower-level facilities.
,Q4. A 35-year-old motorcyclist is ejected at 60 mph and strikes a tree. He is
ambulatory at the scene with minor abrasions. Which mechanism of injury criterion
from Step 3 would indicate trauma center transport?
A. Fall from standing height
B. Ejection from vehicle [CORRECT]
C. Low-speed rear-end collision with airbag deployment
D. Bicycle fall with helmet use and no loss of consciousness
Correct Answer: B
Rationale: Ejection from a vehicle is a high-risk mechanism per CDC Step 3 criteria,
indicating significant energy transfer and potential for occult injuries. Even if the
patient appears stable, ejection mandates trauma center evaluation. Options A, C,
and D represent low-energy mechanisms not meeting Step 3 criteria.
Q5. A 78-year-old patient on warfarin falls from standing height and strikes their
head. They are on a beta-blocker and have a heart rate of 82 bpm. Which special
consideration from Step 4 applies?
A. Age >55 years and anticoagulant use [CORRECT]
B. Only age >65 years applies; anticoagulants are irrelevant
C. Beta-blocker use masks tachycardia but is not a triage criterion
D. Falls from standing height never meet trauma center criteria
Correct Answer: A
Rationale: Step 4 special considerations include: age >55 (some systems use >65),
anticoagulant/bleeding disorder use, burns, pregnancy, EMS provider judgment. Both
age and anticoagulant use independently indicate trauma center transport. Beta-
blockers (Option C) can mask shock but are not formal triage criteria. Option D is
incorrect—ground-level falls in elderly can cause significant intracranial hemorrhage.
, Q6. Which capability distinguishes a Level I trauma center from a Level II trauma
center?
A. 24-hour emergency department coverage by emergency physicians
B. Comprehensive neurosurgical capability and research requirement [CORRECT]
C. Basic radiology and laboratory services
D. Transfer agreements with Level I centers
Correct Answer: B
Rationale: Level I trauma centers require comprehensive neurosurgical services,
research programs, residency training, and continuous readiness for all injury types.
Level II centers provide definitive care but may not have research requirements or all
subspecialties immediately available. Options A, C, and D are capabilities shared by
or below Level II standards.
Q7. A patient meets Step 1 physiologic criteria (GCS 10, SBP 82). The nearest Level I
center is 90 minutes by ground. A Level III center is 15 minutes away. Which
transport decision is MOST appropriate?
A. Transport to Level III for stabilization and then transfer to Level I
B. Direct ground transport to Level I despite the distance
C. Activate aeromedical transport for direct transport to Level I [CORRECT]
D. Stay at scene for 20 minutes establishing two large-bore IVs before transport
Correct Answer: C
Rationale: For patients meeting physiologic criteria with prolonged ground transport
time, aeromedical transport reduces time to definitive care and provides advanced
interventions en route. Option A delays definitive care. Option B subjects the patient
to 90 minutes without trauma center capabilities. Option D violates "scoop and run"
principles for unstable trauma.
