PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Scene Assessment and Safety 1 — Questions and Answers
Question 1: During scene size-up, which component of the primary assessment should be completed BEFORE approaching the patient in a potential hazmat incident?
- Establish IV access and prepare fluid resuscitation
- Identify the substance and determine the safety perimeter (Correct answer)
- Begin airway management from a distance
- Contact medical direction for treatment orders
Correct answer: Identify the substance and determine the safety perimeter
In a potential hazmat incident, the provider must identify the substance involved and establish a safe perimeter before approaching. Attempting patient care without this step exposes the provider to the same hazard, creating additional casualties.
Question 2: A prehospital provider arrives at a scene involving a motor vehicle collision with downed power lines across the vehicle. What is the correct initial action?
- Approach cautiously using rubber-soled boots for protection
- Stage at a safe distance and request utility company response before entering (Correct answer)
- Use a wooden-handled tool to move the lines and access the patient
- Approach only if the lines appear inactive or not sparking
Correct answer: Stage at a safe distance and request utility company response before entering
Downed power lines represent an immediate life threat to responders. The correct action is to stage at a safe distance and request the utility company to de-energize the lines. Appearance alone cannot confirm a line is de-energized — even still lines can be lethal.
Question 3: According to PHTLS principles, which finding during scene size-up would MOST likely indicate the need to request additional resources before patient contact?
- A single patient with an isolated extremity injury
- Multiple patients with varying levels of consciousness at a collision scene (Correct answer)
- One patient who is ambulatory and speaking clearly
- A patient with a laceration who is applying self-pressure
Correct answer: Multiple patients with varying levels of consciousness at a collision scene
Multiple patients with varying consciousness levels suggests a mass casualty incident may be developing. PHTLS emphasizes requesting additional resources early during size-up rather than after care has begun, as response times make early notification critical.
Question 4: What is the PRIMARY purpose of the scene size-up in PHTLS?
- To establish a field diagnosis and begin treatment protocols
- To gather information needed to ensure provider safety and allocate resources appropriately (Correct answer)
- To determine the patient's insurance status and transport destination
- To contact medical direction for standing orders before patient contact
Correct answer: To gather information needed to ensure provider safety and allocate resources appropriately
The scene size-up is designed to assess scene safety, determine mechanism of injury, identify the number of patients, and determine resource needs — all before hands-on patient care begins. This protects providers and ensures adequate resources are mobilized.
Question 5: A provider arrives at a shooting scene and finds the patient on the ground. Law enforcement has not yet arrived. Which action reflects correct PHTLS scene safety principles?
- Rapidly approach and begin hemorrhage control since time is critical
- Stage in a safe location and await law enforcement clearance before entering (Correct answer)
- Enter with a partner, keeping one provider watching for threats
- Approach from behind available cover and assess from a distance
Correct answer: Stage in a safe location and await law enforcement clearance before entering
PHTLS is clear that providers must not enter an active or unsecured violent scene. Staging and waiting for law enforcement to secure the scene is the correct action. Even with a critically injured patient, a provider who becomes a victim adds to the problem rather than solving it.
Question 6: When assessing mechanism of injury at a vehicle collision, which observation is MOST significant for predicting internal injury severity according to PHTLS?
- The color and model year of the vehicle involved
- Intrusion of the passenger compartment and deployment of airbags (Correct answer)
- Whether the vehicle is a sedan versus an SUV
- The posted speed limit on the road where the crash occurred
Correct answer: Intrusion of the passenger compartment and deployment of airbags
Passenger compartment intrusion and airbag deployment are key physical indicators of significant energy transfer to occupants. PHTLS uses these findings to predict injury patterns and trigger higher index of suspicion for serious internal injuries, even in patients who appear stable.
PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Scene Assessment and Safety 1
During scene size-up, which component of the primary assessment should be completed BEFORE approaching the patient in a potential hazmat incident?