23 EMS Operations Practice Questions & Answers

1. 1. During an adult mass-casualty incident you begin START triage. The first patient is breathing 34 times per minute and has a radial pulse. Using START, how should you tag this patient?

   • A.BLACK / Expectant
   • B.GREEN / Minor
   • C.RED / Immediate✓ Answer
   • D.YELLOW / Delayed

   In START, a respiratory rate greater than 30 per minute is an automatic Immediate (RED) tag because it signals inadequate oxygenation and ventilation; you stop and tag without checking perfusion or mental status.

   Source: START triage algorithm (Hoag/Newport Beach), Respirations >30/min = ImmediateReport a problem with this question

2. 2. A patient in an MCI is breathing 24 times per minute, but you cannot feel a radial pulse and capillary refill is 3 seconds. Under START, this patient is:

   • A.GREEN / Minor
   • B.RED / Immediate✓ Answer
   • C.BLACK / Expectant
   • D.YELLOW / Delayed

   Respirations are under 30, so you assess perfusion next; an absent radial pulse (or capillary refill greater than 2 seconds) indicates poor perfusion and requires an Immediate (RED) tag.

   Source: START triage algorithm — Perfusion: no radial pulse / cap refill >2 sec = ImmediateReport a problem with this question

3. 3. During START triage, a patient is breathing 20 times per minute and has a radial pulse, but cannot follow the simple command to squeeze your hand. This patient should be tagged:

   • A.YELLOW / Delayed
   • B.GREEN / Minor
   • C.BLACK / Expectant
   • D.RED / Immediate✓ Answer

   With adequate respirations and perfusion, the final START check is mental status; a patient who cannot follow simple commands is tagged Immediate (RED) because altered mentation may indicate hypoxia or serious head injury.

   Source: START triage algorithm — Mental status: cannot follow commands = ImmediateReport a problem with this question

4. 4. Using JumpSTART on a young child in an MCI, you find the child is not breathing but you can palpate a pulse. Your next action is to:

   • A.Open the airway and give 5 rescue breaths✓ Answer
   • B.Begin chest compressions
   • C.Tag RED and immediately move on
   • D.Tag the child BLACK (expectant) and move to the next patient

   JumpSTART recognizes that pediatric arrests are usually respiratory in origin, so an apneic child WITH a pulse gets 5 rescue breaths; if breathing resumes, tag RED, and if it does not, tag BLACK.

   Source: JumpSTART pediatric triage algorithm (Romig) — apneic + pulse: 5 rescue breathsReport a problem with this question

5. 5. While performing START primary triage in an MCI, which interventions are you permitted to perform on patients as you sort them?

   • A.Only opening the airway and controlling major bleeding✓ Answer
   • B.IV access and splinting fractures
   • C.Full BLS treatment of each patient before moving on
   • D.A complete set of vital signs on each patient

   During primary triage the goal is rapid sorting, so interventions are limited to opening the airway (repositioning) and controlling major hemorrhage; definitive treatment waits until triage is complete—triage precedes treatment.

   Source: START triage — interventions limited to airway positioning and hemorrhage control; triage before treatmentReport a problem with this question

6. 6. You arrive first at a multi-vehicle crash with at least six injured people. Before providing patient care, your priority action is to:

   • A.Load the closest patient and transport immediately
   • B.Establish command, size up the scene, and call for additional resources early✓ Answer
   • C.Start treating the most seriously injured patient right away
   • D.Wait for a supervisor before doing anything

   The first-arriving unit must establish command, perform a scene size-up, and request resources early—not begin treating one patient—because committing to a single patient (freelancing) leaves the incident unmanaged and resources unrequested.

   Source: NIMS/ICS — first-arriving unit establishes command and size-up; request resources early in MCIReport a problem with this question

7. 7. You find an unconscious adult who was struck by a car. There is no family or guardian present. Under what type of consent may you treat him?

   • A.Involuntary consent
   • B.Expressed consent
   • C.Implied consent✓ Answer
   • D.Informed consent

   Implied consent is the legal presumption that an unresponsive or otherwise incompetent patient would consent to the lifesaving care a reasonable person would want under the circumstances.

   Source: U.S. medical-legal standard — doctrine of implied consent for the unresponsive/incompetent patientReport a problem with this question

8. 8. Which patient may legally refuse emergency medical care?

   • A.An alert, oriented adult who understands the risks of refusing✓ Answer
   • B.An unconscious adult with a head injury
   • C.A 15-year-old with a minor laceration and no parent present
   • D.A visibly intoxicated adult who is confused about the date

   Only a competent adult who is alert, oriented, and able to understand the risks and consequences of refusal may legally decline care; intoxication, altered mentation, and minor status all invalidate a refusal.

   Source: U.S. medical-legal standard — valid refusal requires a competent, alert, oriented adultReport a problem with this question

9. 9. A patient later sues, claiming an EMT harmed them. All four of the following must be proven for negligence EXCEPT which is NOT one of the four elements?

   • A.Damages caused by proximate causation
   • B.Malicious intent to harm✓ Answer
   • C.A duty to act
   • D.A breach of the standard of care

   The four elements of negligence are duty to act, breach of that duty (standard of care), damages/harm, and proximate causation linking the breach to the harm; malicious intent is not required—negligence is about a failure to meet the standard, not intent.

   Source: U.S. tort law — four elements of negligence: duty, breach, damages, causationReport a problem with this question

10. 10. An EMT begins caring for a patient, then leaves the scene before another provider of equal or higher training takes over. This is best described as:

    • A.Battery
    • B.False imprisonment
    • C.Assault
    • D.Abandonment✓ Answer

    Abandonment is terminating care of a patient without ensuring that care is transferred to a provider of equal or higher training once a duty to act has been established.

    Source: U.S. medical-legal standard — definition of abandonment (transfer to equal/higher care)Report a problem with this question

11. 11. You respond to a patient in respiratory distress who has a valid, signed DNR order. The DNR means you should:

    • A.Begin CPR immediately regardless of the order
    • B.Withhold all care and only monitor the patient
    • C.Refuse to transport the patient
    • D.Provide comfort and supportive care such as oxygen and positioning✓ Answer

    A valid DNR directs only that resuscitation (CPR) be withheld in cardiac/respiratory arrest; it does not withhold care, so you must still provide comfort and supportive measures such as oxygen, positioning, and suctioning.

    Source: Advance directive / DNR standard — withholds resuscitation only; comfort care continuesReport a problem with this question

12. 12. Under HIPAA, in which situation may you share a patient's protected health information (PHI) without specific written authorization?

    • A.Telling a curious off-duty coworker about the call
    • B.Posting details on social media without using a name
    • C.Giving a verbal report to the receiving hospital staff for treatment✓ Answer
    • D.Describing the patient to a friend who asks

    HIPAA permits disclosure of PHI for treatment, payment, and health-care operations (or when legally required); handing off to the receiving hospital is a treatment disclosure, whereas the other options are unauthorized breaches even without a name.

    Source: HIPAA Privacy Rule — permitted disclosures for treatment, payment, operationsReport a problem with this question

13. 13. You arrive at an overturned tanker leaking an unknown liquid and displaying a placard. As an EMT trained to the awareness level, you should:

    • A.Isolate the area, deny entry, and call for a specialized HazMat team✓ Answer
    • B.Enter immediately to rescue any trapped victims
    • C.Drive downhill and downwind to get closer for a better view
    • D.Begin decontaminating patients inside the hot zone

    EMTs are trained to the awareness level: recognize the hazard, isolate the scene, deny entry, and summon specialized HazMat resources—they do not enter the contaminated zone or attempt rescue/decon without proper training and PPE.

    Source: OSHA HAZWOPER (29 CFR 1910.120) — First Responder Awareness level: recognize, isolate, notifyReport a problem with this question

14. 14. When staging near a hazardous-materials release, how should you position yourself and your ambulance?

    • A.Uphill and upwind, staging in the cold zone✓ Answer
    • B.Downhill and downwind for a faster approach
    • C.As close to the leak as possible to observe it
    • D.Directly within the warm decontamination corridor

    You approach and stage uphill and upwind to avoid drifting vapors and liquid runoff, keeping the command post, staging, and patient treatment in the cold (safe) zone.

    Source: ERG / HazMat control zones — approach uphill/upwind; cold zone for command and treatmentReport a problem with this question

15. 15. In the Incident Command System, which of the following is a Command Staff position rather than a General Staff section?

    • A.Operations Section
    • B.Finance/Administration Section
    • C.Logistics Section
    • D.Safety Officer✓ Answer

    The Command Staff consists of the Safety Officer, Public Information Officer, and Liaison Officer, who report directly to the Incident Commander; Operations, Planning, Logistics, and Finance/Administration are the General Staff sections.

    Source: NIMS/ICS structure — Command Staff (Safety, PIO, Liaison) vs. General Staff sectionsReport a problem with this question

16. 16. In ICS, what is the recommended span of control—the number of subordinates one supervisor should manage?

    • A.1 to 2 subordinates
    • B.Unlimited, as needed
    • C.3 to 7 subordinates (5 is optimal)✓ Answer
    • D.8 to 12 subordinates

    Effective span of control in ICS is 3 to 7 subordinates per supervisor, with 5 being optimal; exceeding this range degrades supervision, so command is subdivided to keep spans manageable.

    Source: NIMS/ICS principle — span of control 3–7 (optimal 5)Report a problem with this question

17. 17. A medical helicopter has landed and the pilot signals you to approach. How should you approach the aircraft?

    • A.From the uphill side on a slope
    • B.From any direction as long as you stay crouched
    • C.From the front, in the pilot's line of sight, only after being signaled✓ Answer
    • D.From the rear, passing near the tail rotor

    Always approach a helicopter from the front within the pilot's line of sight and only after being signaled; the spinning tail rotor is nearly invisible and deadly, so you must never approach from the rear, and on a slope you approach from the downhill side.

    Source: Air medical LZ safety — approach from front in pilot's view; never the tail rotorReport a problem with this question

18. 18. You are driving to a call with lights and siren activated and approach a red traffic light at an intersection. What is required of you?

    • A.You must come to a stop and proceed with due regard only when the way is clear✓ Answer
    • B.You may proceed through without slowing because it is an emergency
    • C.Emergency status exempts you from all traffic laws
    • D.The siren legally grants you the right of way, so proceed

    Lights and siren only request the right of way; under the due-regard standard the operator remains legally responsible for everyone's safety, so you must stop at a red light and proceed cautiously only when clear—most ambulance collisions occur at intersections.

    Source: Emergency vehicle operation — due regard standard; siren requests, not grants, right of wayReport a problem with this question

19. 19. You and a partner must lift a heavy stretcher. Which technique best protects you from injury?

    • A.Keep the weight held out away from your body
    • B.Twist toward the cot as you lift to save a step
    • C.Keep your back straight, lift with your legs, and hold the load close to your body✓ Answer
    • D.Bend at the waist and lift with your back

    The power lift keeps the back straight and locked while using the stronger leg muscles, with the weight held close to the body and no twisting, which minimizes spinal strain and injury.

    Source: EMS body mechanics — power lift: straight back, lift with legs, load close, no twistingReport a problem with this question

20. 20. In which situation is an emergency move (such as a clothes drag) justified before completing a full assessment and spinal precautions?

    • A.When the stretcher is parked far away
    • B.For every trauma patient to speed things up
    • C.Only when there is an immediate danger such as fire, explosion, or hazardous materials✓ Answer
    • D.Whenever the patient asks to be moved

    An emergency move is used only when an immediate danger (fire, explosion, hazardous materials, or the need to reach a critical patient) outweighs the risk of moving without full spinal precautions; you drag along the long axis of the body to protect the spine.

    Source: Patient movement — emergency move indicated only for immediate danger; drag along long axisReport a problem with this question

21. 21. You receive a medication order by radio from online medical control. Before administering the medication, you should:

    • A.Use the patient's full name on the air for clarity
    • B.Carry out the order without confirming, to save time
    • C.Repeat (echo) the order back to medical control to confirm you heard it correctly✓ Answer
    • D.Give your own diagnosis over the radio first

    You echo (repeat back) orders received from medical control so the physician can confirm the order was received accurately before you act, which reduces medication and dosing errors.

    Source: EMS communications — echo/repeat-back of medical control orders to confirm accuracyReport a problem with this question

22. 22. After completing your patient care report (PCR), you notice you wrote the wrong blood pressure. How should you correct this error on the legal document?

    • A.Discard the report and start a new one
    • B.Draw a single line through it, write the correction, and initial and date it✓ Answer
    • C.Erase it completely and rewrite the correct value
    • D.Cover it with correction fluid and write over it

    Because the PCR is a legal document, errors are corrected by drawing a single line through the mistake (leaving it legible), writing the correction, and adding your initials and the date; erasing or obliterating an entry suggests falsification.

    Source: PCR documentation standard — single line through error, correction, initial and date; never eraseReport a problem with this question

23. 23. According to the standard sequence of scene size-up, what is the FIRST step you take upon arriving at any scene?

    • A.Take standard (BSI) precautions and put on appropriate PPE✓ Answer
    • B.Determine the total number of patients
    • C.Identify the mechanism of injury
    • D.Request additional resources

    Scene size-up begins with taking standard/BSI precautions and donning PPE, because provider safety comes first; you then assess scene safety, the mechanism or nature of illness, the number of patients, and the need for additional resources.

    Source: Scene size-up sequence — standard/BSI precautions first, then scene safety, MOI/NOI, patients, resourcesReport a problem with this question

Practice questions modeled on the National EMS Education Standards and NREMT cognitive-exam content areas. Not medical advice and not affiliated with or endorsed by the National Registry of Emergency Medical Technicians (NREMT) or NHTSA. Always follow your instructor, medical director, and local protocols. Study the official materials at nremt.org. Official NREMT →