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.
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.
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.
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.
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.
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.
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.
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.
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.
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.