10 free Paramedic practice questions: Multiple Casualty Incidents, Triage, and Incident Command

Load the immediate patient into the ambulance: Immediate patients do get the ambulance first once resources are free. Three occupants are still unassessed, and one of them could be worse off than the patient you tagged. Loading is a transport decision, and transport waits until the full sort is done.

Transport the immediate patient to the hospital: Transporting the sickest patient makes sense when that patient is the only one. You are the only crew here, and three occupants are still unassessed. Leaving now abandons patients nobody has looked at yet. Transport comes after every occupant has a tag.

Begin treating the immediate patient's breathing: Severe difficulty breathing sounds like a reason to step in right now. During triage, the only care you stop for is opening an airway or controlling heavy bleeding. This patient is already tagged immediate and can wait the short time it takes to sort the other three. One of those three may need one of those quick treatments sooner.

Begin treating the two patients with severe respiratory distress while waiting for rescue crews: The two patients in severe respiratory distress do need care. If you start treating them first, nobody has called for more ambulances or mutual aid. Every patient on this scene is waiting on that request.

Focus all efforts on extricating the two trapped patients from the building: The two trapped patients do need to get out of the building. Putting all your effort into extrication leaves you working alone on a scene that is too big for one unit. Nobody has called the rescue crews yet either.

Triage all eight patients before any treatment or rescue efforts begin: Triage is needed at every MCI. Triaging all eight patients first delays the call for rescue teams, more ambulances, and mutual aid. You already know from the scene size-up that one unit is not enough. The request goes out now, and triage comes after.

Green (minor injuries): Green is for the walking wounded, the patients who get up and walk to the treatment area on their own. This patient cannot walk because of the crush injuries to the lower extremities. Green is out at the very first START step.

Yellow (delayed): Yellow fits a patient who cannot walk but passes all three checks. Those checks are respirations of 30 or fewer a minute, a radial pulse, and following simple commands. The rate of 22 and the strong pulse of 88 do pass. This patient cannot follow simple commands, so the mental status check fails. One failed check makes the tag Red.

Black (expectant): Black in START is for a patient who is still not breathing after you open the airway. This patient is breathing 22 times a minute and has a strong, regular radial pulse. Black does not apply.

Red: all burn injuries require immediate assessment and transport: Some burns do get a Red tag. Examples are burns over a large area, burns to the airway, or burns all the way around a limb with poor perfusion. That call still comes from the START steps, not from seeing a burn. A superficial arm burn on a patient who is walking does not come close.

Yellow: all burn patients must be triaged as Yellow until vitals confirm stability: Yellow is for a patient who cannot walk but has good respirations, a radial pulse, and a normal mental status. This patient walked up to you, so the patient already passed the walking step and is Green.

Black: any patient with a burn injury is classified as nonviable: Black is for patients who are not breathing even after you reposition the airway. Having a burn does not make a patient nonviable. A patient who is walking, talking, and telling you how they feel is clearly viable.

Begin treatment of the most critically injured patient while waiting for additional units: Treating the most critical patient is right once the scene is safe and triage has sorted everyone. The traffic is still moving at highway speeds, and nobody has been triaged. You do not know yet which of the four patients is the most critical. Starting care on one patient skips scene safety and triage.

Wait for fire department to arrive before treating any patients: Waiting for the fire department makes sense when you need extrication. Nothing in this question says anyone is trapped. The moving traffic means you request units and control the hazard now, instead of standing by.

Transport the first patient immediately to reduce the number of patients at the scene: Transporting the first patient does take one patient off the scene. Driving away with that patient leaves the other three with no care. Nobody has done triage or made the scene safe yet, and those steps come before any transport decision.

Enter the tank with a rope and harness to retrieve the patient quickly: A rope and harness is rescue gear, and a quick pull looks like the fastest way to reach this patient. Going in on a rope still puts you inside the confined space. Confined space rescue belongs to a trained technical rescue team, not to the EMS crew.

Have a site supervisor enter the tank first to assess the environment before you proceed: A site supervisor knows the site and can tell you about the tank. The supervisor is not a confined space rescuer either. Sending the supervisor in puts another untrained person into the same tank the patient fell into. If the supervisor goes down too, the rescue team has a second patient in the tank.

Lower a ladder into the tank and direct the patient to climb out while monitoring from above: A ladder gets a patient out without anyone going in. This patient is injured and has not been able to climb out in 15 minutes. A ladder still asks this injured patient to climb. Getting the patient out of the tank is still a technical rescue, and that job belongs to the rescue team.

Enter the house to assess the full scene and determine if other patients require assistance: Checking for more patients is part of the scene size-up once the scene is safe. Right now the shouting and breaking glass mean the house is still dangerous. Going inside puts you in the middle of an assault with no protection. Police can check for other patients once they secure the house.

Quickly assess and transport the patient to the hospital before the situation inside escalates further: Load and go is the right move once you know the scene is safe. The danger here is coming from inside the house, not from the patient. Hurrying through patient care does not remove the threat behind you. You still need police on scene before you get close enough to load anyone.

Provide full assessment and treatment from inside the ambulance while monitoring the house until police arrive: Staying in the ambulance keeps you off the lawn while you wait. A full assessment and treatment is still patient care, and nobody has made this scene safe yet. Staging means you notify dispatch and request police first. Treating the patient in the ambulance a few yards from a disturbance you have not reported is not staging.

To the ambulance, where a running count can be kept: The ambulance looks like an easy place to gather patients and keep a running count. This ambulance is parked in the only clear driveway. Pulling 20 patients toward the ambulance blocks the vehicle and the route the incoming units need in 8 minutes.

To the treatment area once it has been established: A treatment area is where patients go once one has been set up. No other EMS personnel are on scene yet to set one up. Sending patients to a treatment area answers a later stage of the incident, not the first move you have to make now.

To the nearest exit from the collapsed floor section: Gathering patients at the nearest exit does get them off the collapsed floor. The exit is also the passage that arriving crews and other walking patients need to use. A crowd held at the exit blocks that route.

Triage the patients where they stand and tag them for later: Triage is the first thing that happens to most patients at a mass casualty incident. These patients are still wet with the chemical. Triaging them where they stand exposes you, contaminates the tag, and undoes the zones the hazmat team already set up.

Triage the patients as minimal and send them for transport: Patients who walk out on their own are usually the walking wounded, tagged minimal. Being able to walk does not clear a patient for transport. Sending contaminated patients toward the ambulances spreads the chemical into a clean area.

Walk the patients into the treatment area and triage them: Walking a patient straight to the treatment area is the fast move on an ordinary call. Walking these patients in carries the chemical into the treatment area. Decontamination comes before a patient goes into a treatment area, not after.

Tag the patient immediate and move to the next patient: Immediate is the tag for a child who starts breathing after the rescue breaths. This child has a pulse but did not start breathing. In JumpSTART, the child who does not breathe after the trial is expectant.

Give five more rescue breaths and reassess for breathing: A second round of breaths sounds safer than stopping. JumpSTART allows only one trial of five breaths. Repeating the trial holds primary triage on one patient while the rest of the scene goes unsorted.

Begin chest compressions and ventilations: Chest compressions are for cardiac arrest. This child has a palpable distal pulse. A full resuscitation during primary triage also ties you to one patient while everyone else waits to be assessed.