How many questions are on the PHTLS written exam?

The PHTLS written exam contains 60 multiple-choice questions with a 2-hour time limit. A minimum score of 74% is required to pass the written component. Students must also pass a practical skills station to earn certification.

What is the difference between MARCH and ABCDE in PHTLS?

MARCH (Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Hyperthermia) prioritizes life-threatening hemorrhage control before airway management, reflecting lessons from military and tactical medicine. ABCDE (Airway, Breathing, Circulation, Disability, Exposure) follows the traditional sequence. PHTLS teaches providers to choose the appropriate framework based on mechanism and environment.

When is permissive hypotension used in PHTLS?

Permissive hypotension targets a systolic blood pressure of 80–90 mmHg in adult trauma patients with uncontrolled hemorrhage and no traumatic brain injury. The goal is to avoid over-resuscitation that disrupts early clot formation. It is contraindicated in patients with suspected TBI, who require a higher SBP (90+ mmHg) to maintain cerebral perfusion pressure.

Is PHTLS or ATLS better for prehospital providers?

PHTLS is designed specifically for prehospital EMS providers (EMTs, paramedics, flight medics), while ATLS (Advanced Trauma Life Support) targets in-hospital physicians and surgeons. Most EMS agencies and medical directors require PHTLS for field personnel. Some advanced providers pursue both certifications to strengthen their overall trauma management knowledge.

PHTLS Prehospital Trauma Life Support Practice Test PDF (Free Printable 2026)

Download a free PHTLS practice test PDF. Print and study offline for the NAEMT Prehospital Trauma Life Support certification examination.

PHTLS - Prehospital Trauma Life SupportMay 4, 20264 min read

Free PHTLS Practice Test PDF Download

The PHTLS (Prehospital Trauma Life Support) certification exam is administered by NAEMT and is designed for EMS providers who respond to traumatic emergencies. Passing it requires mastery of trauma physiology, systematic patient assessment, and hands-on intervention skills. This free PHTLS practice test PDF lets you study offline, quiz yourself on paper, and build the exam-day confidence you need. Download it, print it, and start drilling the concepts that show up most on the real exam.

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PHTLS Exam Fast Facts

What the PHTLS Exam Covers

Kinematics and Trauma Physiology

PHTLS places heavy emphasis on the mechanism of injury (MOI). You must understand kinematics of trauma — how energy transfer differs between blunt and penetrating forces — and apply that knowledge to predict injury patterns before you even touch the patient.

Primary Survey: MARCH vs. ABCDE

Modern PHTLS uses the MARCH sequence (Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Hyperthermia) for tactical and high-threat environments, while the traditional ABCDE approach remains foundational for standard trauma assessment. Know when and why each framework applies.

Airway Management in Trauma

Expect questions on jaw thrust technique, BVM ventilation, supraglottic airway devices, and the indications for surgical airway intervention. Cervical spine precautions must be maintained throughout airway management unless the scene is unsafe.

Hemorrhage Control

Direct pressure remains first-line. The exam tests proper tourniquet application (placement, timing, documentation), wound packing with hemostatic gauze (kaolin or chitosan-based), and management of junctional hemorrhage where limb tourniquets cannot be placed.

Shock Recognition and Management

Distinguish compensated from decompensated hemorrhagic shock using clinical signs. Understand permissive hypotension — the deliberate acceptance of a lower-than-normal blood pressure target (SBP 80–90 mmHg) to avoid disrupting early clot formation during active hemorrhage.

Thoracic Trauma

Key topics include tension pneumothorax (tracheal deviation, absent breath sounds, JVD, hypotension) and needle thoracostomy decompression at the 2nd intercostal space midclavicular line or 4th/5th ICS anterior axillary line. Also study open chest wound management (3-sided occlusive dressing), hemothorax, and flail chest paradoxical movement.

Spinal Motion Restriction

PHTLS now favors selective spinal immobilization based on clinical criteria (pain, neurological deficit, altered mental status, distracting injury) rather than routine full spinal immobilization for every trauma patient.

Head Trauma and Special Populations

Recognize signs of herniation (Cushing triad: hypertension, bradycardia, irregular respirations). Controlled hyperventilation (ETCO2 ~35 mmHg) is reserved for impending herniation only. Also review the rule of nines for burn surface area, inhalation injury signs, pediatric trauma differences, obstetric trauma, and elderly-specific considerations such as anticoagulation and reduced physiologic reserve.

Free PHTLS Practice Tests Online

Prefer to study on your device? Take our interactive PHTLS practice test online with instant scoring and detailed answer explanations. Combine the online quizzes with the printable PDF above for maximum retention and exam readiness.