TCCC Final Review - CMS Quiz 1

Question 1

Which of the following options best describes where a tourniquet should be applied?
A. as proximal on the affected extremity as possible
B. 2 to 3 inches proximal to the bleeding site
C. On the distal margin of the bleeding site
D. directly on the bleeding site

Answer 1

B. 2 to 3 inches proximal to the bleeding site

Pg 619

Question 2

Which of the following can be used to determine a patient's overall circulatory status (CHECK ALL THAT APPLY)?
A. Pulse
B. Skin color 
C. Capillary refilling time 
D. Pain level

Answer 2

A. Pulse
B. Skin color
C. Capillary refilling time
Pg 115

Question 3

Which of the following is FALSE regarding tourniquets?
A. Tourniquets are often left in place for prolonged periods during surgical procedures
B. Damage to the arm or leg is rare if the tourniquet is left on less than two hours
C. In the face of massive extremity hemorrhage, it is better to accept the small risk of damage to the limb than to have a casualty bleed to death.
D. Tourniquets left in place longer than 4 hours frequently result in tissue necrosis requiring amputation

Answer 3

D. Tourniquets left in place longer than 4 hours frequently result in tissue necrosis requiring amputation
Pg 619

Question 4

The best immediate response to life-threatening extremity arterial bleeding in a combat
environment is to:
A. Apply a tourniquet
B. Apply several steri-strips to the wound, covered by a loose gauze bandage
C. Use a hemostat to clamp the vessel
D. Transport the patient to the nearest sourceof surgical care
E. Elevate the limb

Answer 4

A. Apply a tourniquet

Pg 602-3

Question 5

When compared with other hemostatic agents, which of the following has the LEAST
hemostatic efficacy?
A. HemCon 
B. Combat Gauze
C. Woundstat 
D. Celox

Answer 5

A. HemCon 
Pg 620 (figure 26-6)

Question 6

Which of the following factors have contributed to the Combat Application Tourniquet being
selected as the preferred tourniquet for use in combat? (Check all that apply)
A. It must be maintained carefully before use in order to be effective
B. It abolished radial and femoral arterial blood flow in approximately 75% of uses on healthy adult male test subjects
C. It can be applied rapidly with one hand
D. It is small enough to be carried easily

Answer 6

C. It can be applied rapidly with one hand
D. It is small enough to be carried easily
Pg 603

Question 7

Which of the following is recommended as the first-line treatment for life-threatening
hemorrhage that is not amenable to tourniquet placement
A. Direct digital pressure on the proximal
artery and vein
B. QuikClot
C. HemCon
D. Occlusive pressure dressing
E. Combat Gauze

Answer 7

E. Combat Gauze

Pg 620

Question 8

You are the first responder to the scene of an Improvised Explosive Device (IED) attack. The
area is now secure, and your next patient has multiple small lacerations over his face and
torso, none of which are serious. After checking ABC’s you are sweeping his extremities with
your hands, looking for painful injuries, and, upon moving his left arm it begins to gush with
arterial bleeding from a deep wound over the medial upper arm. Your first action is to:
A. Elevate the arm
B. Tape a small 2x2 gauze dressing over the wound
C. Apply a C.A.T. tourniquet to the arm proximal to the wound
D. Apply digital pressure to the left radius region in an attempt to stop the venous return
E. Reposition the casualty’s arm in an attempt to stop the bleeding

Answer 8

C. Apply a C.A.T. tourniquet to the arm proximal to the wound
Pg 618-620

Question 9

While providing Tactical Field Care, which of the following groups of treatment options
provide the best likelihood for successful hemorrhage control without adverse effects?
A. Pressure points, Combat Gauze, direct pressure with standard dressing
B. Tourniquets, pressure points, Combat Gauze
C. Tourniquets, Combat Gauze, direct pressure with standard dressing
D. Tourniquets, HemCon, direct pressure with standard dressing
E. Apply a hemostat (clamp) to the bleeding vessel

Answer 9

C. Tourniquets, Combat Gauze, direct pressure with standard dressing
Pg 114-5, 618-621

Question 10

You have stablized your casualty and have controlled his bleeding using a C.A.T. Tourniquet on his right upper arm. After insuring that he is protected against hypothermia, you have called in a 9-line MEDEVAC request and are preparing him for CASEVAC. You consider removing the tourniquet prior to transportation. During which of the following circumstances should the tourniquet NOT be removed (check all that apply)?
A. When a physician is present with an alternative method of hemorrhage control readily available
B. When the transportation to a medical facility is expected to be less than two hours
C. When the patient is in shock
D. When the distal extremity is gone

Answer 10

B. When the transportation to a medical facility is expected to be less than two hours
C. When the patient is in shock
D. When the distal extremity is gone
Pg 619

Question 11

When should you consider removing a tourniquet?
A. If the tourniquet has been in place for 4 hours
B. If CASEVAC will happen in less than an hour
C. When the tactical situation permits a qualified person to slowly loosen the tourniquet and place of an alternative method of hemorrhage control
D. Never remove a tourniquet outside of the Operating Room

Answer 11

C. When the tactical situation permits a qualified person to slowly loosen the tourniquet and place of an alternative method of hemorrhage control
Pg 619

Question 12

Who may remove a tourniquet?
A. combat medic
B. physician’s assistant
C. physician
D. both B and C (physician’s assistant and physician, but not combat medic)
E. A, B, and C (combat medic, physician’s assistant, and physician may all remove tourniquets)

Answer 12

E. A, B, and C (combat medic, physician’s assistant, and physician may all remove tourniquets)
Pg. 619

Question 13

While direct pressure can be an effective method for the medic/corpsman to control accessible hemorrhage, which of the following conditions of tactical casualty care are likely to prevent adequate maintenance of pressure? (check all that apply)
A. Inability to stay with patient during transportation
B. Multiple patients
C. Multiple injury sites
D. Enemy fire

Answer 13

A. Inability to stay with patient during transportation
B. Multiple patients 
C. Multiple injury sites
D. Enemy fire
Pg 619-20

Question 14

Combat Gauze is a hemostatic agent useful as a “pressure adjunct” to control hemorrhage. The correct method to use it is:
A. Pour into the wound and observe to confirm clot formation
B. Place dressing inside a tourniquet, then apply the tourniquet in the standard fashion
C. Remove all blood and place onto bleeding vessels without external pressure
D. Apply to bleeding site with three minutes of sustained, direct pressure

Answer 14

D. Apply to bleeding site with three minutes of sustained, direct pressure
Pg 620-621

Question 15

You are treating a casualty with a fragment wound to the right upper arm. You are in the tactical warm zone with good cover and this is your only patient. You initially applied a field dressing and now, ten minutes later, it is soaked with blood. Your next course of action is to:
A. Apply a splint
B. Apply a pressure dressing
C. Apply a tourniquet
D. Remove the initial dressing and pack the wound with gauze

Answer 15

B. Apply a pressure dressing

Pg 114

Question 16

What is the proper method for applying a Combat Application Tourniquet (C.A.T.)?
A. Apply the CAT distal to the wound, twist the Windlass Rod until the bleeding stops, secure the Windlass Rod, mark the casualty with a “T”
B. Apply the CAT proximal to the wound, twist the Windlass Rod until the bleeding stops, secure the Windlass Rod, mark the casualty with the time of tourniquet application
C. Apply the CAT directly over the wound, twist the Windlass Rod until the bleeding stops, secure the Windlass Rod, mark the casualty with the time of tourniquet application
D. Apply the CAT proximal to the wound, twist the Windlass Rod until the bleeding slows, secure the Windlass Rod, mark the casualty with the time of tourniquet application
E. Apply the CAT proximal to the wound, twist the Windlass Rod until the bleeding slows, secure the Windlass Rod, mark the casualty
with a “T”

Answer 16

B. Apply the CAT proximal to the wound, twist the Windlass Rod until the bleeding stops, secure the Windlass Rod, mark the casualty with the time of tourniquet application
Pg 607-10

Question 17

For each of the following casualty descriptions, identify the correct triage category.

1. A casualty in coma with open head injury and brain matter exposed.
2. A casualty with third degree burns over 90% of TBSA who is also in respiratory distress.
3. A casualty with a gunshot wound to the chest in respiratory distress.
4. A casualty with severe, uncontrolled hemorrhage from a traumatic amputation of his right foot.
5. An ambulatory casualty with a 3 cm laceration to the left thigh with slow venous bleeding controlled after applying direct pressure.
6. A casualty with a first degree burn to approximately 2% TBSA on his abdomen.
7. A casualty with an open fracture of the left lower leg.
8. A casualty with traumatic amputation of his left foot; bleeding controlled by C.A.T tourniquet.

A. Expectant
B. Minimal
C. Delayed
D. Immediate

Answer 17

1. A
2. D
3. D
4. C - because hemorrhage is controllable with CAT
5. B
6. B
7. no peripheral pulse present = D
   peripheral pulse present = B
8. C
   Pg 106

Question 18

In the START triage system decision points are based on:
A. Type of injury discovered in the casualty
B. Medical resources available
C. Anticipated survival times of casualties
D. Respiratory rate, perfusion, and mental status

Answer 18

D. Respiratory rate, perfusion, and mental status

Pg 105-6

Question 19

Using the triage algorithm for Tactical Combat Casualty Care, what triage category would the
following casualty fall into?
A 25 year old male was shot in the mid-thigh and initially had pulsatile bleeding from the wound. He applied a tourniquet himself and the bleeding is controlled by the time you reach him. He is conversant and following commands. You note that his pulse is 95, respiratory rate 20, and he has a strong radial pulse. He is complaining of severe pain.
A. Secondary 
B. Delayed 
C. Expectant 
D. Minor 
E. Immediate 
F. Minimal

Answer 19

B. Delayed

Pg 675

Question 20

A casualty who has a weak radial pulse has a systolic blood pressure (SBP) of ~80 mm Hg and a mortality of 32%. A casualty with an absent radial pulse suggests a SBP of less than 50 mm Hg and a mortality of \_\_%.
A. 32% 
B. 52% 
C. 72% 
D. 92%

Answer 20

D. 92%

Pg 675

Question 21

Casualties with blunt or penetrating wounds to the head in which there is obvious massive brain damage and unconsciousness are unlikely to survive with or without emergency evacuation.
True
False

Answer 21

True

Pg 674 Figure 30-2 (Triage in TACEVAC number 9)

Question 22

A Mass Casualty Incident (MCI):
A. Chemical or biological agents are suspected
B. You have patients that you do not know how to treat
C. The number of patients exceeds the immediate capacity of on-scene resources
D. Occurs only when there are more than 15 casualties

Answer 22

C. The number of patients exceeds the immediate capacity of on-scene resources
Pg 101

Question 23

When performing triage, which of the following best correlates with survival and the need for
life-saving interventions:
A. Pulse rate 
B. Respiratory rate 
C. Pulse oximetry reading 
D. Glasgow coma scale (GCS)

Answer 23

D. Glasgow coma scale (GCS)

Pg 548-9

Question 24

During the primary survey, you attempt to manage your casualty’s airway. Which of the following considerations is true?
A. Every trauma casualty with a significant mechanism of blunt injury is suspected of spinal injury
B. Because you must maintain cervical spine stabilization, you cannot perform advanced airway interventions
C. You should immobilize the casualty’s spine with in line stablization and a spine board before attempting to open the airway
D. You must protect the cervical spine from excessive motion only if there is evidence of neurological damage

Answer 24

A. Every trauma casualty with a significant mechanism of blunt injury is suspected of spinal injury
Pg 112-3

Question 25

You are alone, treating a patient who is supine, with obvious facial injuries, as well as trauma to the extremities. The patient is unconscious and in respiratory distress–making gurgling noises with respiration. You perform a jaw thrust, detecting a mandible fracture, which causes some improvement in his respiratory status. There is no obvious arterial bleeding. The next step you would take to stabilize this patient is to:
A. Bandage the facial injuries
B. Complete the primary survey
C. Complete the secondary survey
D. Insert an oral pharyngeal airway (OPA)
E. Start an I.V. to treat any potential shock

Answer 25

D. Insert an oral pharyngeal airway (OPA)

Pg 112-3

Question 26

Traumatic cardiopulmonary arrest has a dismal prognosis. Performing CPR on a trauma victim puts prehospital providers at risk of exposure to blood and bodily fluids, and it also diverts resources away from other casualties who may be viable. Which of the following is NOT a reason to withhold CPR?
A. A penetrating trauma patient has no signs of life (no pupillary reflexes, no spontaneous movement, no organized cardiac rhythm on ECG >40 bpm).
B. Casualties of drowning, lightning strike, and hypothermia.
C. A blunt trauma patient is pulseless and apneic on arrival of prehospital care providers.
D. A patient has suffered an obviously fatal injury (eg, decapitation), or evidence exists of dependent lividity, rigor mortis, and decomposition.

Answer 26

B. Casualties of drowning, lightning strike, and hypothermia.
Pg 129

Question 27

In the Primary Survey, the memory aid “ABCDE” is used to describe the sequence of tasks to perform in conducting the Primary Survey in a combat situation. In this pneumonic, the “E” stands for Expose. This means that:
A. Avoid exposure to enemy gunfire
B. “E” actually stands for Exsanguinating hemorrhage
C. The patient must be completely exposed in order to inspect the entire body for injuries
D. The patient must be completely exposed after completing the Secondary Survey
E. Avoid any exposure as the patient might get hypothermia

Answer 27

C. The patient must be completely exposed in order to inspect the entire body for injuries
Pg 117

Question 28

There are four primary reasons for an individual to exhibit a decreased level of consciousness or aberrant behavior. Which of the following is NOT one of these primary reasons?
A. Conversion disorder 
B. Metabolic derangements
C. Intoxication 
D. Central nervous system injury 
E. Decreased cerebral oxygenation

Answer 28

A. Conversion disorder

Pg 116

Question 29

Which of the following is true regarding transportation of trauma victims to definitive medical care (check all that apply)?
A. For some critically injured trauma patients, initiating transport is the single most important aspect of definitive care in the field
B. Transportation should only be considered once detailed field assessments and interventions are completed
C. Scene time should not exceed 10 minutes
D. Research demonstrates trauma patients have better outcomes when medics spend an extra 3-5 minutes “fixing patients” on scene
E. Transporting patients to definitive medical care within the “golden period” is crucial for survival

Answer 29

A. For some critically injured trauma patients, initiating transport is the single most important aspect of definitive care in the field
C. Scene time should not exceed 10 minutes
E. Transporting patients to definitive medical care within the “golden period” is crucial for survival
Pg 111 & 125

Question 30

While conducting your primary survey on a combat casualty with a full complement of required medical equipment, you observe that your casualty is breathing spontaneously with a ventilatory rate of 25. Which of the following is the most appropriate immediate intervention:
A. Provide assisted ventilation with a Bag-Valve-mask (BVM) and supplemental oxygen
B. Provide supplemental oxygen
C. You need more information before delivering oxygen
D. Observe; No supplemental oxygen is indicated

Answer 30

B. Provide supplemental oxygen

Pg 113-114

Question 31

You are in South Dakota responding to the scene of a motor vehicle collision (MVC). The closest hospital (without trauma services) is 20 miles due south of your location, and the closest trauma center is 40 miles due north. Using the Triage Decision Scheme originally published by the American College of Surgeons, should the following patient be transported to the closest hospital or to the trauma center?

A 65 year old man ran off the road and struck a tree while traveling at 30 mph. He was wearing his seatbelt and his airbags did deploy. Another vehicle then struck the passenger side of his vehicle. There is about two feet of passenger space intrusion. He is a little confused (GCS is 14), but has normal vital signs. He has no obvious major injuries on primary or secondary survey. AMPLE history: A: no drug allergies, M: takes coumadin for atrial fibrillation, P: no other medical problems aside from atrial fibrillation, L: last ate 5 hours ago, E: events as above; he ran off the road to avoid hitting a stray dog that ran in front of his
car.
A. closest hospital (20 miles south)
B. trauma center (60 miles north)

Answer 31

B. trauma center (60 miles north)

Pg 127

Question 32

The primary concerns for assessment and management of the trauma casualty, in order of importance, are:
Neurologic function, Airway, Hemorrhage control, Ventilation/Oxygenation & Perfusion

Answer 32

Airway 
Ventilation/Oxygenation Hemorrhage control 
Perfusion 
Neurologic function
Pg 110

Question 33

Based on the following information, what is this patient’s revised trauma score (RTS)?

A 30 year old woman was involved in a 65 mph car accident; she ran into a guardrail and
flipped her car. She will not open her eyes to command or pain, makes unintelligible noises,
and withdraws from painful stimuli. Her vital signs are: BP 80/50, RR 25, O2 sat 99%
receiving supplemental oxygen, and temperature 97.3 F.
A. 1 
B. 2 
C. 3 
D. 4 
E. 5 
F. 6 
G. 7
H. 8
I. 9 
J. 10
K. 11
L. 12

Answer 33

I. 9

Pg 116 & 125

Question 34

During the secondary survey, you should
A. Use a “look, listen, and feel” approach to evaluate the entire body for additional injuries
B. Ensure that you complete your full secondary survey before evacuating the patient to definitive care
C. Perform a complete history and physical
D. Ensure that you complete your full secondary survey before treating life-threatening injuries

Answer 34

A. Use a “look, listen, and feel” approach to evaluate the entire body for additional injuries
Pg 119

Question 35

Rapid and accurate patient assessment is important for the pre-hospital provider for which of the following reasons (select one)?
A. The “golden period” is the first 2 hours post injury, and is the critical period during which the casualty must receive definitive care
B. The “golden hour” means that most casualties will survive if they receive definitive care within the 1st hour post-injury
C. The “golden period” means that many casualties have less than an hour to receive definitive care, and that the earlier the casualty can be transported to a facility to receive definitive care, the higher his chances
of survival are
D. The rapid application of critical lifesaving interventions during the “golden period” at the point of injury is not as important as early
transport to definitive care
E. Delays in transport will extend the “golden period” allowing the pre-hospital provider to provide definitive emergency treatment at the
point of injury

Answer 35

C. The “golden period” means that many casualties have less than an hour to receive definitive care, and that the earlier the casualty can be transported to a facility to receive definitive care, the higher his chances
of survival are
Pg 110

Question 36

During full expiration, what is the maximum upward excursion of the diaphragm anteriorly? This is important because a penetrating thoracic wound at or below this line may have traversed both the thoracic and abdominal cavities.
A. 2nd intercostal space 
B. 4th intercostal space 
C. 6th intercostal space 
D. 8th intercostal space 
E. 10th intercostal space

Answer 36

B. 4th intercostal space

Pg 122

Question 37

Fill in the blank: The need for advanced airway management (including intubation) is based on many factors. All other factors being equal, a GCS score at or below \_\_\_ prompts properly trained prehospital personnel to strongly consider intubation.
A. 8 
B. 4 
C. 12 
D. 5

Answer 37

A. 8

Pg 425

Question 38

You arrive on the scene of an accident and ask the victim, “What happened to you?” If the casualty answers with a coherent explanation in complete sentences, the prehospital provider can reasonably conclude that:
The casualty has a patent airway, sufficient respiratory function to support speech, adequate cerebral perfusion, and reasonable neurologic functions. There are probably no immediate threats to this patient’s life.
True
False

Answer 38

True

Pg 112

Question 39

The primary survey begins with:
A. a simultaneous, or global, overview of the status of a patient’s respiratory, circulatory, and neurologic systems
B. Airway assessment and management with cervical spine stabilization
C. Checking to see if the patient is breathing
D. Exposing the patient’s body (removing clothing) in order to identify sources of bleeding

Answer 39

A. a simultaneous, or global, overview of the status of a patient’s respiratory, circulatory, and neurologic systems
Pg 112

Question 40

During the secondary survey, which of the following should be evaluated as part of the neurological exam (check all that apply)?
A. The pupils are checked for equality of response
B. The pupils are checked for equality of size
C. The pupils are checked for retinal hemmorrhage
D. The GCS score is calculated
E. Motor and sensory function are evaluated

Answer 40

A. The pupils are checked for equality of response
B. The pupils are checked for equality of size
D. The GCS score is calculated
E. Motor and sensory function are evaluated
Pg 124

Question 41

In performing the Primary Survey, the following approach should be taken:
A. All relevant data is collected before initiating any treatment
B. Manage life threatening conditions as they are discovered
C. Complete the full primary and secondary survey and then initiate treatment for life threatening conditions
D. Complete the XABCDE steps (primary survey) and then initiate treatment for life threatening conditions

Answer 41

B. Manage life threatening conditions as they are discovered

Pg 117

Question 42

Critical casualties cannot remain in the field for care other than that needed to stabilize them for transport, unless they are trapped or other complications exist that prevent early transportation. Prehospital providers should minimize on-scene delay and rapidly move casualties to an appropriate medical facility.
True
False

Answer 42

True

Pg 110

Question 43

In the civilian EMS system, control of hemorrhage should first be attempted with direct pressure at the bleeding site. If that doesn’t work, the next steps are elevation of the injured extremity and pressure on appropriate “pressure points” to control hemorrhage. If all of the
above fail, a tourniquet should be used as a last resort.
True
False

Answer 43

False

Pg 115

Question 44

You are assessing a trauma casualty and observe that, when you palpate his left arm, he opens his eyes and grabs his left arm, but otherwise his eyes remain closed. He is muttering incomprehensibly, but says "banana oil" and grabs his left arm when you ask him if he's ok. He will not answer or respond to any direct questions. His Glasgow Coma Scale (GCS) is:
A. 12 
B. 8 
C. 9 
D. 6 
E. 5

Answer 44

C. 9

Pg 116

Question 45

During the secondary survey, the first responder should take an "AMPLE" history. What does the M stand for?
A. Medications 
B. Meals 
C. Medical history 
D. Mechanism of injury 
E. Military history

Answer 45

A. Medications

Pg 121

Question 46

A patient has been intubated. What is their maximum Glascow Coma Score (GCS)?
A. 15T 
B. 14T 
C. 10T 
D. 8T 
E. 6T 
F. 5T

Answer 46

C. 10T

Pg 116

Question 47

A control element or incident command system (ICS) should be established as part of the
response to a mass casualty situation. Functions of the control element/ICS should include:
A. Area security and limiting access
B. Establishing communications between
treatment areas and organizations within and
outside of the incident area
C. Organizing medical and non-medical
personnel for staffing areas
D. Ensuring an adequate supply of blood and
other class VIII items and other resources
E. All of the above

Answer 47

E. All of the above

Pg 99-105

Question 48

Who is the best person to perform initial triage in a mass casualty situation?
A. An Air Force emergency medicine
physician (residency trained, board-certified).
B. Navy “0000” corpsman (quad zero – a
corpsman who is very junior, has completed
“A” school and hasn’t gone on for specialized
training yet). Since he doesn’t know much
yet, he won’t be able to help with casualty
treatment, so he should stay out in the triage
area. This will leave the better-trained people
free to provide direct patient care.
C. A Navy medical service corps officer
(admin officer, typically Master’s-level
education, who is intimately familiar with the
administrative aspects of the evacuation
process but has no experience with direct
patient care).
D. An Army operating room nurse

Answer 48

A. An Air Force emergency medicine
physician (residency trained, board-certified).
Pg 673

Question 49

If a casualty cannot follow commands, and has a weak or absent radial pulse, what is the risk
of mortality?
A. 32% 
B. 52% 
C. 72% 
D. 92%

Answer 49

D. 92%

Pg 675

Question 50

Using the triage algorithm for Tactical Combat Casualty Care, what triage category would the
following casualty fall into?

A 25 year old male was shot in the mid-thigh and initially had pulsatile bleeding from the
wound. He applied a tourniquet himself and the bleeding is controlled by the time you reach
him. He is conversant and following commands. You note that his pulse is 95, respiratory rate 20, and he has a strong radial pulse. He is complaining of severe pain.
A. Secondary
B. Delayed
C. Immediate
D. Minimal
E. Expectant
F. Minor

Answer 50

B. Delayed

Pg 675

Question 51

You respond to a Mass-Casualty situation and the scene is safe. The NEXT step in the
process of performing mass-casualty triage is:
A. Move expectant patients out of the
treatment area
B. Establish a command post (CP), Casualty
Collection Points (CCPs), and routes of
access
C. Perform required immediate lifesaving
interventions
D. Separate the Minimal and Delayed
casualties from the Immediate through verbal
commands
E. Assign initial triage categories

Answer 51

B. Establish a command post (CP), Casualty
Collection Points (CCPs), and routes of
access
Pg 676

Question 52

Which of the following is the leading cause of occupational injury/death for EMS workers?
A. Violence at the scene (belligerent victims
and/or bystanders)
B. Gunshot wounds
C. Bloodborne pathogen incidents
D. Accidents while working at the scene of a
Motor Vehicle Crash (MVC)
E. Ambulance collisions during the response
phase

Answer 52

E. Ambulance collisions during the response
phase
Pg 89

Question 53

Using the START (Simple Triage and Rapid Treatment) triage protocol, how would you
characterize the following casualty?
A 35 year old man was injured during a terrorist attack; a vehicle full of explosives was
detonated in an underground parking garage, causing the overlying building to collapse. A
large piece of metal broke free and has punctured his abdomen; the metal enters his
abdomen at the umbilicus and exits from his right flank. His right lower leg (tibia) has an open fracture and severe deformity. His respiratory rate is 25/minute; his radial pulse is present.
He is alert and following commands, though he appears to be in excruciating pain.
A. dead
B. immediate
C. minor
D. delayed
E. secondary

Answer 53

D. delayed

Pg 106

Question 54

Using the START (Simple Triage And Rapid Treatment) triage protocol, how would you
characterize the following casualty?
A 65 year old man who was injured in a terrorist bombing; part of a building collapsed on him.
He has an altered level of consciousness (won’t follow simple commands), but has a normal
respiratory rate (15/minute), capillary refill

Answer 54

D. immediate

Pg 106

Question 55

In responding to a mass casualty incident, HAZMAT or Weapons of Mass Destruction (WMD) may modify your plan for scene setup. Which of the following is true when setting up a triage scene when HAZMAT is present?
A. The hot zone is the area in which the
hazmat is located and is located downwind of
the cold zone
B. The warm zone is the area in which
complete medical care is rendered and is
located upwind of the hot zone
C. The warm zone is the area in which
decontamination occurs and is located
downwind of the hot zone
D. The cold zone is the area in which medical
personnel are staged and is located
downwind of the hot zone
E. The cold zone is the area in which
complete medical care is rendered and is
located downwind of the warm zone

Answer 55

A. The hot zone is the area in which the
hazmat is located and is located downwind of
the cold zone
Pg 97-98

Question 56

When performing triage, which of the following best correlates with mortality or the need for
life-saving interventions (select all that apply)?
A. Respiratory rate
B. systolic blood pressure
C. Glasgow coma scale (GCS)
D. Pulse oximetry reading

Answer 56

B. systolic blood pressure
C. Glasgow coma scale (GCS)
Pg 673-4

Question 57

The goal of triage is:
A. priority transport for patients with longbone
fractures
B. the greatest care for the greatest number
of patients and the maximal utilization of
resources
C. that intoxicated patients wait until nonintoxicated patients can be assessed and
treated first
D. immediate identification of all patients with
likely traumatic brain injury (TBI)

Answer 57

B. the greatest care for the greatest number
of patients and the maximal utilization of
resources
Pg 673

Question 58

Older nurses report more needle-stick injuries compared to their younger counterparts.
True
False

Answer 58

True

Question 59

Which of the following is NOT an effective preventative measure for Bloodborne Pathogens
while working as a first-responder?
A. Hepatitis C vaccination 
B. Proper use of sharps containers
C. Hepatitis B vaccination 
D. Physical barriers (gloves, masks, face shields, eye protection)
E. Using needle-less systems for drug
delivery

Answer 59

A. Hepatitis C vaccination

Pg 92

Question 60

When decontaminating casualties at a mass casualty scene, which of the following is true:
A. It is best to have the patient do as much of
the decontamination as possible if he is able
B. A solution of 0.5% hypochlorite should be
used to decontaminate injuries to the eye
C. The highest priority is getting medical care
to the casualties
D. You should avoid using large amounts of
water since it may create chemical reactions
and secondary burns to the casualty
E. You should use neutralizing agents for
chemical burns on casualties

Answer 60

A. It is best to have the patient do as much of
the decontamination as possible if he is able
Pg 97-99

Question 61

What is the first priority of the first responder at a trauma scene?
A. Correcting airway problems in all critical
casualties
B. Establishing triage points
C. Rapidly evacuating all casualties to
medical treatment facilities capable of
providing definitive care
D. Scene assessment to establish safety
E. Situation assessment to determine what
happened and likely mechanisms of injury

Answer 61

D. Scene assessment to establish safety

Pg 88

Question 62

A small U-Haul moving van is packed with explosives (explosive capacity approximately
equivalent to 10,000 pounds of TNT). What is the safe evacuation distance in feet for building
evacuation distance and outdoor evacuation distance?
A. building: 70 ft
outdoor: 850 ft
B. building: 150 ft
outdoor: 1,850 ft
C. building: 650 ft
outdoor: 2,750 ft
D. building: 860 ft
outdoor: 3,750 ft
E. building: 1,240 ft
outdoor: 6,500 ft
F. building: 1,570 ft
outdoor: 7,000 ft

Answer 62

D. building: 860 ft
outdoor: 3,750 ft
Pg 98

Question 63

You are in the Tactical Field Care phase of patient care and evaluate a casualty that is not
breathing. What is your next step in the primary survey?
A. Place casualty in the expectant category
B. Perform abdominal thrusts
C. Re-position (open) the airway using a jaw
thrust maneuver
D. Clear a presumed airway obstruction with
forceps

Answer 63

C. Re-position (open) the airway using a jaw
thrust maneuver
Pg 106

Question 64

For each of the following casualty descriptions, identify the correct triage category.
1. A casualty in coma with open head injury
and brain matter exposed.
2. A casualty with third degree burns over 90% of TBSA who is also in respiratory distress.
3. A casualty with a gunshot wound to the
chest in respiratory distress.
4 A casualty with severe, uncontrolled hemorrhage from a traumatic amputation of his right foot.
5. An ambulatory casualty with a 3 cm laceration to the left thigh with slow venous bleeding controlled after applying direct pressure.
6. A casualty with a first degree burn to
approximately 2% TBSA on his abdomen.
7. A casualty with an open fracture of the left
lower leg.
8. A casualty with traumatic amputation of his left foot; bleeding controlled by C.A.T
tourniquet.
A. Delayed
B. Expectant
C. Immediate
D. Minimal

Answer 64

1  B
2 C
3 C
4 C
5 D
6 D
7 A
8 D

Pg 673

Question 65

In the START triage system decision points are based on:
A. Respiratory rate, perfusion, and mental
status
B. Type of injury discovered in the casualty
C. Medical resources available
D. Anticipated survival times of casualties

Answer 65

A. Respiratory rate, perfusion, and mental
status
Pg 106

Question 66

Hemorrhagic shock is a vitally important topic in combat casualty care. Shock is defined as a
widespread lack of tissue perfusion with oxygenated red blood cells that causes anaerobic metabolism and decreased cellular energy production, which in turn can lead to death. Assessment for shock involves evaluation of the skin temperature, skin color, blood pressure, level of consciousness, and capillary refilling time. In austere tactical environments, though, most of these signs may not be appreciable. What are the most useful clinical signs for combat medical personnel to identify shock on the battlefield?
A. skin temperature and color
B. capillary refilling time and skin color
C. radial pulse and mentation
D. blood pressure and capillary refilling time

Answer 66

C. radial pulse and mentation

Pg 623

Question 67

Which of the following factors have contributed to the Combat Application Tourniquet being
selected as the preferred tourniquet for use in combat? (Check all that apply)
A. It abolished radial and femoral arterial
blood flow in approximately 75% of uses on
healthy adult male test subjects
B. It can be applied rapidly with one hand
C. It must be maintained carefully before use
in order to be effective
D. It is small enough to be carried easily

Answer 67

B. It can be applied rapidly with one hand
D. It is small enough to be carried easily
Pg 603

Question 68

Regarding the “care under fire” phase of TCCC: If the casualty has suffered only penetrating
trauma (not blunt), there is no requirement to immobilize the spine with a C-collar before
moving a casualty out of a firefight.
True
False

Answer 68

True

Pg 602

Question 69

Pulse oximetry devices are inexpensive, small, and (generally) very accurate, and they are
increasingly being used on the battlefield. Regarding pulse oximetry, which of the following statements is false?
A. Even in normal (healthy, uninjured) volunteers, pulse oximetry values decrease
with altitude. This may be important during
aircraft evacuations, as well as when operating in mountainous regions. Normal levels at the following altitudes are:
Sea level: 97.5%
5,000 ft: 96.2%
8,000 ft: 93.7%
12,000 ft: 86.1%
B. Although pulse oximetry can be a useful
adjunct in care of casualties in the tactical
setting, pulse oximetry should NOT be
considered a portable “all-in-one” monitor of
oxygenation, pulse rate, rhythm regularity,
and overall cardiopulmonary well-being.
Over reliance on pulse oximetry may lead to
delays in therapy or inappropriate decision
making in the field.
C. Methemoglobin (as may occur in
casualties who have previously been treated
with dapsone, primaquine, or other related
antimalarials) may lead to falsely low
saturation readings – typically about 85%.
D. Pulse oximetry is a valuable adjunct in
assessing the viability of an injured extremity,
and in determining the presence or absence
of a vascular injury.
E. Carboxyhemoglobin (as may occur with
significant smoke inhalation and carbon
monoxide poisoning) may lead to falsely
normal or high saturation readings.

Answer 69

D. Pulse oximetry is a valuable adjunct in
assessing the viability of an injured extremity,
and in determining the presence or absence
of a vascular injury.
Pg 628; 650

Question 70

Choices for hemorrhage control during the Care Under Fire phase of TCCC must be made
with which of the following considerations?
A. Salvaging the casualty’s life must always
take priority over saving the casualty’s limb
B. HemCon dressings should be used as the
first-line treatment given their superior
performance to all other dressings and
treatments
C. Tourniquets must be used with caution
since complications are common
D. Direct pressure and pressure dressings
are preferred since they provide better means
of controlling bleeding while the casualty is
being moved

Answer 70

A. Salvaging the casualty’s life must always
take priority over saving the casualty’s limb
Pg 602, 620

Question 71

Although ATLS teaches starting two large-bore (14- or 16-gauge) intravenous (IV) catheters
for fluid resuscitation in trauma casualties, the 18-gauge catheter is preferred in the field
setting because of the ease of cannulation.
True
False

Answer 71

True

Pg 622

Question 72

What options are available for fluid resuscitation in a combat setting (select all that apply)?
A. Hetastarch solutions
B. Oral rehydration
C. Hypertonic Saline/Dextran (HSD)
D. Limited (hypotensive) fluid resuscitation

Answer 72

A. Hetastarch solutions
B. Oral rehydration
D. Limited (hypotensive) fluid resuscitation
Pg 624

Question 73

Who may remove a tourniquet?
A. combat medic 
B. physician's assistant
C. physician 
D. both B and C (physician's assistant and
physician, but not combat medic)
E. A, B, and C (combat medic, physician's
assistant, and physician may all remove
tourniquets)

Answer 73

E. A, B, and C (combat medic, physician’s
assistant, and physician may all remove
tourniquets)
Pg 619

Question 74

A nasopharyngeal airway is inserted to maintain the casualty’s airway as part of which phase
of TCCC?
A. Both care under fire and tactical field care
B. Care under fire
C. Neither care under fire and tactical field
care.
D. Tactical field care

Answer 74

D. Tactical field care

Pg 600, 613

Question 75

You and a casualty are under fire. The casualty has a large left arm wound that is severely
hemorrhaging. You can administer treatment without endangering the mission or yourself.
What is the best option to control the life-threatening hemorrhage?
A. Apply direct pressure to wound for at least
10 minutes
B. Pressure dressing
C. HEMCON dressing
D. Apply pressure to a proximal Pressure
Point
E. Tourniquet

Answer 75

E. Tourniquet

Pg 602

Question 76

Which of the following is the correct TCCC preferred pain management for a casualty who is unable to fight?
A. Tylenol, 650 mg 2 PO q8 hours
B. Fentanyl citrate, 800 mcg IV, repeat once
after 15 min if needed
C. Morphine Sulphate, 5 mg IV/IO q10 min
D. Mobic, 15 mg PO qd

Answer 76

C. Morphine Sulphate, 5 mg IV/IO q10 min

Pg 628-9

Question 77

A casualty has a significant wound to his leg. The casualty is coherent and has a palpable
radial pulse. The wound has been dressed and the bleeding is controlled. What should you
do next?
A. Nothing, unless the casualty loses
consciousness
B. Initiate a saline lock
C. Initiate a saline lock and begin administering intravenous fluids
D. Wrap in blankets to prevent hypothermia

Answer 77

B. Initiate a saline lock

Pg 613-14

Question 78

What is the procedure of choice for relieving tension pneumothorax on the battlefield?
A. Apply a three-sided dressing to any
open/sucking chest wound
B. Tube thoracostomy (chest tube) 
C. Endotracheal intubation 
D. Needle thoracentesis

Answer 78

D. Needle thoracentesis

Pg 616

Question 79

Which of the following interventions should NOT be part of the basic management plan for
“care under fire?”
A. direct or expect casualty to remain
engaged as a combatant, if appropriate
B. place an advanced airway and provide
ventilation if the casualty has respiratory
compromise
C. direct the casualty to move to cover and
apply self-aid if able
D. stop life-threatening external hemorrhage
if tactically feasible
E. return fire, take cover

Answer 79

B. place an advanced airway and provide
ventilation if the casualty has respiratory
compromise
Pg 600

Question 80

Crystalloid fluids (normal saline and lactated ringers) are the fluids of choice for prehospital
resuscitation of combat casualties?
True
False

Answer 80

False

Pg 623-24

Question 81

You and a casualty are under fire. The casualty is conscious, but bleeding heavily. He is able
to fire his weapon. There are multiple casualties who you have not yet been able to evaluate. What should you direct him to do first?
A. Return fire, move to cover, and administer
self-aid if able
B. Put down his weapon and help you triage
the other casualties
C. Administer buddy aid
D. Call in a 9-line MEDEVAC request for you

Answer 81

A. Return fire, move to cover, and administer
self-aid if able
Pg 600 Figure 25-1

Question 82

When performing care under fire, what aid is rendered before moving the casualty?
A. Control bleeding
B. Relieve tension pneumothorax
C. Administer antibiotics
D. Cardiopulmonary resuscitation.
E. Control pain and infection

Answer 82

A. Control bleeding

Pg 602

Question 83

Which of the following options best describes where a tourniquet should be applied?
A. directly on the bleeding site
B. 2 to 3 inches proximal to the bleeding site
C. as proximal on the affected extremity as
possible
D. At the distal margin of the bleeding wound

Answer 83

B. 2 to 3 inches proximal to the bleeding site

Pg 619

Question 84

What is the most common etiology of preventable death on the battlefield?
A. Compromise of the airway leading to
asphyxia
B. Spinal trauma
C. Overwhelming infection as a late complication of battlefield wounds
D. Exsanguinating hemorrhage
E. Pulmonary edema from battlefield toxins

Answer 84

D. Exsanguinating hemorrhage

Pg 602

Question 85

You have moved your casualty to a safe zone, controlled bleeding from an extremity wound
with a tourniquet, administered fluids, and pain medications. It has taken you approximatley
2.5 hours to accomplish these tasks. Before evacuating your patient, which of the following
should be completed? (check all that apply)
A. Take measures to prevent hypothermia
B. Reassess any previously applied
tourniquets
C. Administer antibiotics
D. Complete head-to-toe assessment to
ensure there are no additional wounds that
need attention
E. Document treatments and assessments on
a TCCC casualty card

Answer 85

A, B, C, D, E

Pg 647-48

Question 86

Which of the following should you treat first if exposed to enemy fire?
A. A closed fracture to the left arm
B. Laceration to the right arm
C. Breathing difficulties with a penetrating
chest wound
D. Uncontrolled bleeding from the left thigh

Answer 86

D. Uncontrolled bleeding from the left thigh

Pg 602

Question 87

You are driving in a convoy when an improvised explosive device (IED) explodes next to one of your vehicles. Insurgents begin to attack from the opposite direction. You witness a total of four casualties. The FIRST step in the Care Under Fire phase of TCCC is to:
A. Call out to the patients to find out which
ones are ambulatory
B. Return fire and take cover as directed or
required
C. Perform triage on the casualties
D. Obtain help from other medics
E. Find the patient with the most severe
injuries

Answer 87

B. Return fire and take cover as directed or
required
Pg 600 Figure 25-1

Question 88

You are caring for a casualty with a penetrating abdominal wound and anticipate a prolonged
period before he will be evacuated for surgery. The casualty has a normal state of
consciousness and ability to swallow. Should you allow him to take oral fluids?
A. The casualty should remain NPO (nothing
by mouth), because the risk of emesis and
aspiration upon induction of anesthesia is
very high.
B. The casualty should remain NPO (nothing
by mouth), because fluid intake may cause
more intraperitoneal contamination as the
fluid taken by mouth transits the
gastrointestinal tract (which may be
perforated from the penetrating trauma).
C. The casualty should be allowed to take
both fluids and MRE (meal, ready-to-eat)
solids. The oral fluids will help prevent
dehydration. The constipating effects of the
MRE will slow gut transit time, and the
preservatives in the MRE will decrease gut
bacterial count – thereby limiting
intraperitoneal GI contamination.
D. The casualty should be allowed to take
fluids by mouth. This will conserve your
limited IV fluid supplies, and will not have any
deleterious effect on the casualty.

Answer 88

D. The casualty should be allowed to take
fluids by mouth. This will conserve your
limited IV fluid supplies, and will not have any
deleterious effect on the casualty.
Pg 625

Question 89

In the Casualty Evacuation Care (CASEVAC) phase of TCCC, transfusion of blood products
may be considered. All of the following considerations must be addressed in order to
consider transfusion (select all that apply)
A. Obtaining PRBCs/plasma must be
logistically feasible in the area of operations
B. A high enough probability of delayed
evacuation must exist to warrant prehospital
transfusion
C. A protocol must be in place that has been
coordinated with the approved by the blood
bank and unit physician
D. Combat medical personnel must be well trained in transfusion protocols

Answer 89

A, B, C, D

Pg 650

Question 90

The “Tactical Field Care” phase of TCCC is defined as:
A. the phase when medical personnel and
their casualties are no longer under effective
hostile fire, and more extensive care can be
provided
B. This stage of care only pertains to
casualties who sustain injuries while training
C. Used interchangeably between all levels of
care performed within a tactical environment
D. The care rendered once the casualty has
been picked up by an aircraft, vehicle, or boat
for transportation to a higher echelon of care

Answer 90

A. the phase when medical personnel and
their casualties are no longer under effective
hostile fire, and more extensive care can be
provided
Pg 592

Question 91

It may be difficult to establish intravenous (IV) access when casualties are in shock. If
resuscitation is required and IV access is not obtainable, what is the preferred alternate route
for administering fluids and medications?
A. central venous access
B. intraosseous access
C. saphenous cutdown
D. subcutaneous injection

Answer 91

B. intraosseous access

Pg 622