Skip to content
Free NREMT practice questionsFree EMT practice questions · Primary Assessment

10 free EMT practice questions: Transport Decision (Rapid vs. Focused)

These are real questions from the same bank the app draws from. Each one is written to the NREMT EMT content specifications and kept inside the EMT scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

Work through all 10, then move on to the next topic. When you want the full picture, the free EMT diagnostic covers every topic in one sitting. No account needed for any of it.

Question 1 of 10

A 45-year-old patient with a history of heavy alcohol use presents with severe, constant epigastric pain that radiates to the back. The pain began after a night of heavy drinking and is somewhat relieved by leaning forward. The patient reports nausea and vomiting. What is the most appropriate EMT-scope management?

Show the answer and rationale

Correct answer · Supportive care, position of comfort, history, and transport

This patient has acute pancreatitis. The pain is severe, constant, in the epigastric area, and goes through to the back. The pain started after a night of heavy drinking and gets a little better when the patient leans forward. The patient also has nausea and vomiting. The pancreas is inflamed, and nothing in the field can diagnose or treat pancreatitis. Your care is supportive. Put the patient in a position of comfort and watch for signs of shock or getting worse. Get a good history, and ask about alcohol use and gallstones, since those are the two most common causes. Then transport for evaluation.

Why the others are wrong

Give oral antacids and reassess before deciding on transport: Antacids make sense for a lot of epigastric pain, and they are harmless in most cases. Antacids do nothing for an inflamed pancreas. Waiting to see if the antacids work before you decide on transport only delays care. Pancreatitis can progress to shock and organ failure.

Treat as gastritis; the pain followed a heavy drinking episode: Gastritis from alcohol has the same trigger and also causes epigastric pain. Pain that goes straight through to the back and pain that eases when leaning forward both point past gastritis. Both of those findings come from an organ that sits in the back of the abdomen, like the pancreas. Gastritis does not cause them.

Encourage a small meal to settle the stomach before transport: Eating is the wrong thing to tell this patient. Food makes the pancreas release more digestive enzymes, and those enzymes make the inflammation worse. Patients with pancreatitis get nothing by mouth for that reason.

Question 2 of 10

A 68-year-old patient reports sudden inability to swallow immediately after eating steak at a restaurant. The patient is anxious, drooling, and able to speak clearly and breathe without difficulty. The patient points to their mid-chest as the location of the problem. What is the most appropriate EMT-scope management?

Show the answer and rationale

Correct answer · Keep the patient NPO, allow a position of comfort, and transport for evaluation, since the airway is patent

This patient has a piece of steak stuck in the esophagus, and the airway is open. The patient speaks clearly and breathes without difficulty, even while drooling and pointing to the mid-chest. The trachea is open and only the esophagus is blocked. The food is lodged above the lower esophageal sphincter. Saliva cannot be swallowed past the blockage, so the saliva backs up and drools out. Air still moves freely through the larynx. This is called steakhouse syndrome. Steakhouse syndrome is not a foreign body airway obstruction. Give nothing by mouth, let the patient stay in a position of comfort, and transport. Clearing the esophagus takes an endoscopy at the hospital.

Why the others are wrong

Attempt to manually remove the obstruction by performing a deep blind finger sweep of the throat: A finger sweep is for an object you can see or feel in the back of the mouth. Even then, a finger sweep is discouraged. This blockage is in the esophagus at the mid-chest, well past where a finger can reach. A blind sweep can push the food further down, cause vomiting, or injure the airway.

Perform abdominal thrusts immediately, treating the obstruction as a life-threatening airway emergency: Abdominal thrusts are right for a true foreign body airway obstruction. In that case an object blocks the trachea, and the patient cannot speak or move air well. This patient talks clearly and breathes without trouble, so the airway is open. Thrusts would treat an airway emergency that is not happening, and thrusts will not move food stuck in the esophagus.

Encourage the patient to drink water forcefully to push the impacted food down into the stomach: Drinking water forcefully to wash the food down is a home remedy aimed at pushing the food into the stomach. The esophagus is the part that is blocked. Drinking against the blockage tends to cause vomiting and aspiration instead of clearing anything. Forcing fluids is not a field treatment EMTs are taught.

Question 3 of 10

A hiking group calls EMS for a member who has had a headache and mild nausea since arriving at a high-altitude campsite yesterday. Today, other members report the patient is now unsteady on their feet and cannot walk in a straight line, though the patient is still able to answer questions appropriately. What is the most appropriate field management?

Show the answer and rationale

Correct answer · Administer oxygen if available and arrange immediate descent to a lower altitude; do not allow further ascent

This patient has high-altitude cerebral edema, which is swelling of the brain from altitude. The headache and nausea started after arriving at the high campsite yesterday. Today the patient is unsteady and cannot walk in a straight line. Losing balance like that is called ataxia. Low oxygen at altitude makes the blood vessels in the brain widen and leak. The brain swells, and the pressure inside the skull goes up. The swelling affects the parts of the brain that control balance. The patient still answers questions appropriately, but the ataxia means this is past simple acute mountain sickness. Once ataxia shows up, no medicine and no oxygen can take the place of getting the patient lower. Give oxygen if you have it. Start the descent now, and do not let the patient go any higher.

Why the others are wrong

Continue monitoring at the current altitude and reassess in a few hours before making a decision about descent: Resting and rechecking at the same altitude fits acute mountain sickness with only a headache and nausea. This patient now cannot walk in a straight line. Once balance is affected, waiting hours to decide lets the swelling get worse. The patient could slip into a coma before the descent even starts.

Treat the unsteadiness as dehydration with oral fluids and rest, remaining at the current campsite altitude: Dehydration is common at altitude and causes headache, nausea, and lightheadedness that can look like unsteadiness. A patient who truly cannot walk in a straight line has rising pressure inside the skull, not a fluid problem. Fluids and rest at the same altitude leave the brain swelling untreated, and the swelling keeps getting worse.

Have the patient rest in a tent and continue the planned itinerary the next day if he feels better: Resting a day and then hiking on is the plan for someone who is just tired. This patient has ataxia on top of a headache and nausea that are getting worse. Climbing higher makes brain swelling worse, so going on with the trip is dangerous.

Question 4 of 10

A 45-year-old patient is alert and oriented. Skin is pale and cool to the touch, heart rate is 118/min, and blood pressure is 88/56 mmHg. Respiratory rate is 22/min. The patient reports feeling dizzy when standing 5 minutes ago but denies any obvious bleeding. Which transport decision is most appropriate?

Show the answer and rationale

Correct answer · Immediately load the patient and provide rapid transport to the nearest appropriate facility

This patient is in shock and needs rapid transport now. The blood pressure is 88/56, the heart rate is 118, and the skin is pale and cool. A blood pressure of 88/56 means the patient has moved past simple compensation into hypotension. The pale, cool skin comes from the vessels in the skin tightening to push blood to the core. The respiratory rate of 22 is part of the same compensation. Perfusion to the cells is already failing, not just at risk. What matters now is getting the patient to a facility that can treat the cause of the shock. Do the rest of your assessment and give oxygen on the way.

Why the others are wrong

Perform a focused assessment on the lower extremities and transport non-emergently: A focused assessment and non-emergent transport fit a stable patient. This patient is not stable, with a blood pressure of 88/56 and a heart rate of 118. Emergent transport comes first, and the rest of the assessment happens on the way.

Perform a complete secondary assessment at the scene before transport: A complete secondary assessment is the normal next step once the primary assessment is clear. The primary assessment here already found shock, with a heart rate of 118 and a pressure of 88/56. The secondary assessment can happen in the moving ambulance. Doing it on scene holds up transport.

Place the patient on high-flow oxygen and reassess vitals in 5 minutes before deciding on transport mode: High-flow oxygen is real shock care, and reassessing vitals is routine. A pressure of 88/56 with a heart rate of 118 already tells you where this patient is heading. Waiting five minutes on scene spends time this patient does not have. Give the oxygen on the way.

Question 5 of 10

A 68-year-old patient is found unresponsive in the bedroom by family. The scene is safe. On primary assessment, the airway is patent and breathing is adequate at 14/min with good air movement. Skin is warm and dry. Vital signs: P 72/min, BP 130/76 mmHg, SpO₂ 97% on room air. Which transport decision is most appropriate?

Show the answer and rationale

Correct answer · Rapid transport; unresponsiveness is a life threat regardless of vital sign stability

Unresponsiveness is a life threat on its own. You make the transport decision from the primary assessment. The primary assessment looks for life threats in the airway, breathing, circulation, and mental status. This patient fails on mental status. The pulse of 72, the blood pressure of 130/76, the saturation of 97%, and breathing at 14 are all normal. Normal numbers mean the body is holding up right now. They say nothing about why the brain is not working. An unresponsive patient also cannot protect their own airway. Position the patient, keep suction ready, and go. Stroke, bleeding in the brain, low blood sugar, overdose, a post-ictal state, and sepsis can all cause unresponsiveness. Every one of them needs a hospital quickly.

Why the others are wrong

Non-urgent transport; stable vital signs indicate a minor event: Non-urgent transport fits stable vital signs when the primary assessment is also normal and the complaint is minor. This patient is unresponsive, so the primary assessment already found a problem with mental status. Normal vital signs in an unresponsive patient show how much reserve is left. They do not show how serious the problem is.

Focused assessment at the scene; transport only if vitals become abnormal: A focused assessment is a real step, but it comes after the life threats are handled. Do the focused assessment en route, not on scene. Waiting for the vital signs to turn abnormal means waiting for the body to stop compensating. By then it is the last moment you can act, and outcomes are worst.

Begin supplemental oxygen and reassess; transport urgently only if the patient regains consciousness: Giving oxygen as support is reasonable. Waiting for the patient to wake up before you transport urgently is the part that is wrong. Waiting keeps an unresponsive patient on scene too long. Most of the causes of unresponsiveness do not get better on the bedroom floor.

Question 6 of 10

A 68-year-old patient is found by the patient's daughter unable to speak clearly. The daughter states the patient was well 30 minutes ago. The patient is alert but confused, with obvious slurred speech and drooling. On examination, there is facial asymmetry with drooping on the right side, and the right arm drifts downward when held against gravity. Vital signs: P 82/min, R 16/min, BP 158/92 mmHg, skin warm and dry. Which transport decision is most appropriate?

Show the answer and rationale

Correct answer · Perform primary assessment and rapid transport to the nearest appropriate facility; reassess en route

This patient is having a stroke. The daughter says the patient was normal 30 minutes ago. Normal 30 minutes ago puts this patient inside the treatment window. The hospital can still give clot busting drugs, called fibrinolytics, or pull the clot out with a procedure called a thrombectomy. The patient also has the FAST findings: facial droop on the right, the right arm drifting down, and slurred speech. The T in FAST is the time the patient was last known well. In a stroke, a blocked or bleeding blood vessel in the brain cuts off oxygen to the brain cells. The brain tissue around the damage can still be saved if blood flow comes back quickly. Every minute on scene uses up that window. Do your primary assessment, transport fast to a facility that can treat stroke, and reassess on the way.

Why the others are wrong

Perform a complete secondary assessment and detailed neurological exam at the scene: A full secondary assessment and detailed neurological exam fit a stable patient whose problem is not time sensitive. The facial droop, slurred speech, and arm drift already make the FAST screen positive. A detailed exam adds nothing that would change your transport decision. The exam only uses up minutes this patient cannot get back.

Obtain baseline vital signs and repeat assessment every 5 minutes at the scene: Repeat vitals every 5 minutes fit a patient you are watching on scene before you decide to transport. This patient has a known onset 30 minutes ago, and the treatment window is already running.

Contact medical control for guidance before deciding whether rapid transport is necessary: Calling medical control first fits a call where the protocol is unclear or a treatment needs permission first. The FAST findings already meet stroke alert criteria. You do not need permission to transport this patient, and the call to medical control only delays you.

Question 7 of 10

An EMT responds for a 34-year-old patient pulled from a backyard pool after being submerged for several minutes. The patient is unresponsive, is breathing 8 times per minute with poor chest rise, and has a weak carotid pulse. Bystanders state the patient waded in from the shallow end and that there was no dive and no fall. The EMT's partner has begun positive pressure ventilations. Which physical examination approach is most appropriate?

Show the answer and rationale

Correct answer · A systematic full-body scan of every body region

This patient is unresponsive, so the secondary assessment is a systematic full-body scan. A focused exam is for a responsive medical patient or a minor mechanism of injury. A focused exam depends on the patient telling you what hurts. An unresponsive patient cannot report pain. The patient also cannot confirm what happened in the pool. A patient who was under water for several minutes is usually unresponsive, like this one. Check every body region. You are looking for hidden life threats and injuries, even though nobody suspects trauma.

Why the others are wrong

A focused examination of the chest and lungs: A focused exam of the chest and lungs fits a responsive patient who complains of trouble breathing. Submersion does hurt the lungs. This patient is unresponsive, and the level of response decides the type of exam, not the body system you suspect.

A focused examination guided by the bystanders' account: A focused exam guided by what happened works for a responsive patient who can back up the story. The bystanders say there was no dive and no fall. This patient cannot answer questions, so nobody can confirm or rule out their account. Taking a bystander's story as proof that nothing else is hurt is the most common way hidden injuries get missed. That's why you check the whole body.

A neurologic examination with repeated pupil checks: A neurologic exam with pupil checks fits a patient whose problem looks like it is in the brain. Being unresponsive can look that way. A neurologic exam skips the chest, abdomen, arms, and legs. Those are the places the hidden life threats would be.

Question 8 of 10

An EMT is caring for a 24-year-old patient who caught a foot on a stair tread and fell one step. The patient is alert and oriented, the airway is patent, and breathing is unlabored. The vital signs are BP 124/78 mmHg, P 88/min, R 16/min, and SpO₂ 99% on room air. The left lower leg is painful, swollen, and angulated, with a strong pedal pulse and normal sensation in the foot. No other injury is found. Which action is most appropriate before moving the patient to the ambulance?

Show the answer and rationale

Correct answer · Splint the injured leg to reduce pain during movement

Splint the leg before you move this patient. The airway is open, the breathing is unlabored, and the vital signs are normal. The only injury is the left lower leg, and the foot still has a strong pedal pulse and normal sensation. Nothing here is a life threat, so you do not need to rush off the scene. How fast you leave depends on the primary assessment, not on how bad the injury looks. With no life threat, easing the pain matters more than saving a minute. A leg that is painful, swollen, and angulated gets splinted before the patient is moved. Splinting first cuts down on pain, more soft tissue injury, and more bleeding during the lift and carry.

Why the others are wrong

Complete a systematic full-body scan of every region: A full-body scan is for a patient with a significant mechanism of injury. This patient fell one step. A fall of one step is not a significant mechanism. The primary assessment is normal and there is one obvious injury. This patient needs a focused exam of the injured leg.

Move the patient to the stretcher and splint en route: Splinting en route is for a critically injured patient, where every minute on scene counts. This patient has a normal primary assessment and one isolated leg injury. Splinting first keeps the move from causing more pain and more injury.

Begin high-concentration oxygen before moving the patient: Oxygen is for a patient who is hypoxic or not breathing well enough. This patient's breathing is unlabored and the SpO₂ is 99% on room air.

Question 9 of 10

An EMT is called for an 84-year-old patient who tripped on a rug and has an isolated deformed, swollen ankle with a strong pedal pulse. The patient is alert and oriented, reports no head strike, and has no chest discomfort at rest. The vital signs are BP 142/84 mmHg, P 86/min, R 16/min, and SpO₂ 97% on room air. A family member reports the patient was hospitalized last month for unstable angina and has had chest discomfort with minimal exertion since. The ankle has been splinted. Which transport decision is most appropriate?

Show the answer and rationale

Correct answer · Prompt transport, completing the remaining assessment en route

Transport this patient promptly. The ankle injury on its own is minor, but the heart history makes this patient potentially unstable. The patient was hospitalized last month for unstable angina and has had chest discomfort with minimal exertion since. The pain and stress of the ankle injury can make the angina worse. A past medical problem counts toward how stable a patient is, even when the patient has no symptoms right now. Get moving and finish the rest of the assessment on the way to the emergency department. Age adds to the risk too. Older patients are more likely to be seriously hurt or die from trauma, and their findings are harder to spot.

Why the others are wrong

Transport without urgency, since the injury is isolated: An isolated ankle injury with stable vital signs would normally be a routine transport. This patient also has unstable angina. The pain and stress of even a minor injury can bring on a cardiac event.

Delay transport until a head-to-toe examination is complete: A complete exam on scene is thorough, but it costs time. A patient who could become unstable gets the rest of the assessment en route.

Delay transport until an advanced life support unit responds: ALS is the right call when a patient needs care you cannot give. This patient has no chest discomfort at rest, and the vital signs are stable. ALS has nothing to treat right now. Waiting for ALS only uses up the time prompt transport is meant to save.

Question 10 of 10

A 45-year-old patient has acute onset chest pain and difficulty breathing. The primary assessment finds an alert and anxious patient with a patent airway, rapid and shallow breathing, and pale, diaphoretic skin. The vital signs are BP 96/62 mmHg, P 118/min, R 24/min, and SpO₂ 90% on room air. Which transport decision is most appropriate?

Show the answer and rationale

Correct answer · Emergent transport with high-concentration oxygen and reassessment en route

This patient is unstable. The chest pain comes with signs of shock and low oxygen. The SpO2 is 90% on room air, the BP is 96/62, the pulse is 118, and the skin is pale and diaphoretic. Oxygen delivery to the tissues is already failing. The fast pulse and the pale skin show the body trying to make up for it. The heart speeds up, and the vessels in the skin narrow to push blood to the core. Keep scene time short. Put high-concentration oxygen on right away. Transport emergent and keep reassessing on the way to the hospital.

Why the others are wrong

Non-emergent transport; have the patient walk to the ambulance and position the patient comfortably: Walking to the ambulance is fine for a stable patient. This patient has a BP of 96/62 and an SpO2 of 90%. Walking raises the heart's oxygen demand in a patient who is already low on oxygen. This patient goes on the stretcher.

Non-emergent transport by stretcher, reassessing the vital signs every 15 minutes: The stretcher is right, and the vital signs do need rechecking. Rechecks every 15 minutes and non-emergent transport are for a stable patient. A pulse of 118, a BP of 96/62, and an SpO2 of 90% make this patient unstable. An unstable patient gets reassessed every 5 minutes on an emergent transport.

Delay transport on scene until a paramedic unit arrives to assume patient care: Waiting for a paramedic unit makes sense when your crew truly cannot manage the patient. You can give oxygen and move this patient now. Staying on scene only adds time for a patient who is already in shock.

Find out which EMT topics are costing you points

Ten questions on one topic tell you about that topic. The free diagnostic covers every EMT topic and breaks your results down by topic, so you know what to drill next. No card, no signup to try it.

Take the free EMT diagnostic

More free EMT practice questions by topic