PHTLS - Prehospital Trauma Life Support Scene Assessment and Safety — Questions and Answers
Question 1: During scene size-up, what should the prehospital provider determine about the mechanism of injury?
- Only whether the injury was intentional or accidental
- The forces involved, body areas potentially affected, and number of patients (Correct answer)
- The exact speed of the vehicle at impact
- Whether the patient has insurance coverage
Correct answer: The forces involved, body areas potentially affected, and number of patients
Understanding the mechanism helps providers estimate energy transfer, predict injury patterns, and make appropriate triage and transport decisions.
Providers should determine: type of event, forces and energy involved, body regions likely affected, number of patients, and need for additional resources. For MVCs, this includes intrusion, rollover, ejection, and windshield damage.
Question 2: What does PHTLS identify as the most common hazard that injures or kills emergency responders at scene?
- Hazardous materials exposure
- Traffic-related incidents at roadway scenes (Correct answer)
- Structural collapse
- Electrical hazards
Correct answer: Traffic-related incidents at roadway scenes
Traffic-related incidents, including being struck by passing vehicles, are the leading cause of line-of-duty injuries and deaths for emergency responders.
Safe positioning practices include parking apparatus to create a buffer zone, wearing high-visibility reflective vests, placing cones and flares upstream, and positioning the largest vehicle at an angle upstream to protect the work zone.
Question 3: When should a prehospital provider NOT enter a trauma scene?
- When the patient appears critically injured
- When active hazards exist that have not been controlled (Correct answer)
- When bystanders are present
- When the incident occurred more than 30 minutes ago
Correct answer: When active hazards exist that have not been controlled
Providers should never enter a scene with uncontrolled hazards as becoming a victim reduces available resources.
Examples include active shooter situations, hazardous materials, structural instability, active fire, downed power lines, and hostile environments. An injured provider becomes an additional patient requiring rescue resources.
Question 4: What information should be relayed to dispatch during the scene size-up that may change the response?
- Patient's name and date of birth
- Number of patients, apparent severity, special hazards, and resource needs (Correct answer)
- Exact diagnosis of each patient's injuries
- Estimated time to clear the scene
Correct answer: Number of patients, apparent severity, special hazards, and resource needs
Early communication about patient count, severity, hazards, and resource needs allows dispatch to send appropriate additional resources.
Critical information includes exact location, number of patients, apparent severity, specific hazards, resource needs, and access/egress issues. This allows proactive resource deployment.
Question 5: According to PHTLS, how should a prehospital provider approach a trauma patient at a crime scene?
- Avoid the patient until police complete their investigation
- Provide patient care while minimizing disturbance to potential evidence (Correct answer)
- Collect all evidence and give it to police before treating
- Ignore all crime scene considerations and focus only on patient care
Correct answer: Provide patient care while minimizing disturbance to potential evidence
Patient care is the priority, but providers should minimize evidence disturbance when possible.
Practical steps include documenting the patient's initial position, avoiding unnecessary movement of objects, cutting around bullet holes in clothing, and noting anything unusual observed. No patient should ever have care delayed to preserve evidence.
Question 6: What role does environmental assessment play in the PHTLS scene size-up?
- It only matters for hypothermia risk
- It identifies weather, terrain, lighting, and conditions that affect patient care and provider safety (Correct answer)
- It determines which hospital to transport to
- It is only relevant for wilderness rescue scenarios
Correct answer: It identifies weather, terrain, lighting, and conditions that affect patient care and provider safety
Environmental conditions including weather, terrain, lighting, temperature, and accessibility all affect patient care and provider safety.
Weather affects hypothermia risk and helicopter availability. Terrain influences access and transport options. Lighting affects assessment quality. Temperature extremes influence treatment priorities. These factors must be integrated into clinical decision-making.
Question 7: During a mass casualty incident, what triage system does PHTLS reference for initial field triage?
- Glasgow Coma Scale scoring
- START (Simple Triage and Rapid Treatment) (Correct answer)
- APACHE II scoring
- Revised Trauma Score
Correct answer: START (Simple Triage and Rapid Treatment)
The START triage system allows rapid categorization of multiple patients into immediate, delayed, minor, and expectant categories.
START triage uses three simple assessments: respiratory rate, capillary refill/pulse, and ability to follow commands to categorize patients in approximately 30-60 seconds each. Categories are Green (Minor), Yellow (Delayed), Red (Immediate), and Black (Expectant/Deceased).
Question 8: What is the significance of the 'mechanism of injury' step in the CDC Field Triage Decision Scheme?
- It is the first and most important step
- It is Step Three, used when physiologic and anatomic criteria are not met but high-energy mechanism suggests occult injury (Correct answer)
- It replaces all other triage criteria
- It only applies to pediatric patients
Correct answer: It is Step Three, used when physiologic and anatomic criteria are not met but high-energy mechanism suggests occult injury
Step Three captures patients who appear stable but have high-energy mechanisms suggesting potential for serious occult injuries.
Criteria include falls >20 feet, MVC >20 mph with intrusion, motorcycle crashes >20 mph, auto vs. pedestrian thrown or run over, and ejection from vehicle. These patients should be transported to a trauma center even if initially stable.
Question 9: How does PHTLS recommend managing multiple patients at a scene when resources are limited?
- Treat the most severely injured patient first regardless of survival probability
- Triage all patients, prioritize those most likely to survive with intervention, and request additional resources (Correct answer)
- Treat patients in the order they are found
- Focus exclusively on pediatric patients first
Correct answer: Triage all patients, prioritize those most likely to survive with intervention, and request additional resources
PHTLS teaches triaging all patients to identify those who will benefit most from immediate intervention, maximizing the number of survivors.
This means treating RED patients first with life-saving interventions, YELLOW next, GREEN last, and not allocating scarce resources to BLACK patients unlikely to survive. Requesting additional resources early is critical.
Question 10: What personal protective equipment does PHTLS recommend as minimum standard for trauma scene operations?
- Surgical gown and cap
- Gloves and eye protection at minimum, with additional PPE based on scene hazards (Correct answer)
- Only gloves are necessary
- Full hazmat suit for all trauma scenes
Correct answer: Gloves and eye protection at minimum, with additional PPE based on scene hazards
PHTLS recommends gloves and eye protection as minimum PPE, with additional protection added based on specific scene hazards.
Scene-specific additions include high-visibility reflective vests for roadway scenes, helmets for structural instability, respiratory protection for smoke or hazmat, and turnout gear for fire scenes. PPE must be donned BEFORE patient contact.
Question 11: According to PHTLS, what should a provider do if scene conditions deteriorate during patient care?
- Continue patient care regardless of changing conditions
- Reassess safety, consider withdrawing if conditions become unsafe, and protect the patient if possible (Correct answer)
- Abandon the patient immediately
- Call for law enforcement only
Correct answer: Reassess safety, consider withdrawing if conditions become unsafe, and protect the patient if possible
Scene safety is dynamic. If conditions deteriorate, providers must reassess and may need to rapidly relocate or withdraw.
Conditions can change: fires spread, structures weaken, weather worsens, perpetrators return. Options include rapid patient movement, requesting appropriate resources, withdrawing to a safe distance, or sheltering in place.
Question 12: Why does PHTLS emphasize determining the number of patients during scene size-up?
- For billing and insurance purposes
- To determine resource needs, triage requirements, and whether to declare a mass casualty incident (Correct answer)
- To satisfy reporting requirements only
- To decide whether to treat or just transport
Correct answer: To determine resource needs, triage requirements, and whether to declare a mass casualty incident
Patient count determines whether available resources are sufficient and how to prioritize care.
A single ambulance crew finding 5 patients must immediately shift from individual patient care to mass casualty management. Early accurate patient counts help hospitals prepare. PHTLS warns that initial counts may be inaccurate.
PHTLS - Prehospital Trauma Life Support Scene Assessment and Safety
During scene size-up, what should the prehospital provider determine about the mechanism of injury?
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