PHTLS Scene Assessment and Safety 5 — Questions and Answers
Question 1: Which component of the PHTLS scene assessment identifies whether additional units, air transport, or specialty teams are needed?
- Mechanism of injury determination
- Resource assessment and request (Correct answer)
- Patient triage category assignment
- Vital sign trending
Correct answer: Resource assessment and request
Resource assessment during scene size-up determines what additional personnel, equipment, or specialty teams must be requested early.
Question 2: A provider arrives at a bar fight scene where police have not yet arrived and participants are still arguing. The correct action is:
- Quickly grab the most critically injured patient and leave
- Stage at a safe distance until law enforcement secures the scene (Correct answer)
- Ask bystanders to restrain combatants while providing care
- Announce loudly that you are EMS to de-escalate the situation
Correct answer: Stage at a safe distance until law enforcement secures the scene
EMS should never enter an unsecured scene involving active violence; staging until law enforcement clears the scene is mandatory.
Question 3: What does 'mechanism of injury with significant kinetic energy' indicate to the PHTLS provider?
- The patient will only have external injuries
- Internal injuries are likely even without obvious external signs (Correct answer)
- Spinal immobilization is never required
- The patient can be transported without further assessment
Correct answer: Internal injuries are likely even without obvious external signs
High-energy mechanisms transfer force to internal structures, making occult injury likely even when external findings appear minor.
Question 4: When caring for a patient near a highway, which traffic control measure is the EMS crew's responsibility?
- Setting up cones and flares to redirect traffic lanes
- Notifying dispatch of the need for traffic management and following law enforcement direction (Correct answer)
- Stopping traffic personally by standing in the roadway
- Calling the state DOT for immediate lane closure
Correct answer: Notifying dispatch of the need for traffic management and following law enforcement direction
EMS providers should notify dispatch and coordinate with law enforcement for traffic control rather than personally directing highway traffic.
Question 5: A provider notes that a patient's injuries are inconsistent with the reported mechanism. What should this finding prompt?
- Documentation of the discrepancy and transport without further inquiry
- Consideration of abuse or assault and mandatory reporting if indicated (Correct answer)
- Reassignment of the call to a higher-level provider
- Immediate law enforcement notification before patient assessment
Correct answer: Consideration of abuse or assault and mandatory reporting if indicated
Injuries inconsistent with stated MOI should raise suspicion for abuse or assault and trigger mandatory reporting obligations.
Question 6: Which situation would prompt a PHTLS provider to request air medical transport during scene assessment?
- Any patient with a GCS below 15 in an urban area
- Ground transport time exceeding 30 minutes to a trauma center for a critical patient (Correct answer)
- All geriatric patients regardless of mechanism
- Patients with penetrating trauma in suburban areas
Correct answer: Ground transport time exceeding 30 minutes to a trauma center for a critical patient
Air medical transport is indicated when ground transport time to a trauma center exceeds approximately 30 minutes for critical trauma patients.
Question 7: During scene assessment at a pedestrian-versus-vehicle collision, the provider notes the windshield is cracked in a spider-web pattern at head height. This finding suggests:
- The vehicle was traveling at low speed and injury is unlikely
- The pedestrian likely struck the windshield, indicating significant head and neck forces (Correct answer)
- The driver is the primary patient of concern
- Spinal injury is definitively ruled out by the impact geometry
Correct answer: The pedestrian likely struck the windshield, indicating significant head and neck forces
A spider-web windshield pattern at head height indicates the pedestrian's head impacted the glass, suggesting significant forces to the head and cervical spine.
PHTLS Scene Assessment and Safety 5
Which component of the PHTLS scene assessment identifies whether additional units, air transport, or specialty teams are needed?