1. A 60-year-old female with a history of diabetes is found confused at her home. Her family states she was fine this morning but became increasingly disoriented over the past hour. On assessment, she opens her eyes to voice, can tell you her name but not where she is, and is diaphoretic with cool, clammy skin. Her blood glucose reads 38 mg/dL. Based on this clinical picture, what is the most likely cause of her altered level of consciousness, and what should be your immediate intervention?

2. A patient appears to be in severe distress, is pale and diaphoretic, and is clutching the abdomen. What is your immediate action?

3. A 71-year-old male with severe COPD requires supplemental oxygen. After applying 2 L/min via nasal cannula, his SpO2 increases from 84% to 97%. The patient becomes drowsy and his respiratory rate decreases from 18 to 8 breaths per minute. What is the MOST appropriate action?

4. A 70-year-old male with a history of diabetes is found confused at home by his family. When you speak to him, he opens his eyes and looks at you but cannot tell you what day it is or where he is. He is able to state his name. What is his AVPU status and orientation level?

5. An EMT arrives at a residence and finds a 45-year-old male sitting on the edge of his bed, leaning forward with his hands on his knees. His skin is pale and diaphoretic, and he speaks in two-word sentences. Based on the general impression, what is this patient’s priority status?

6. What does the acronym MOI stand for in the context of scene size-up?

7. A 52-year-old male with diabetes is found unresponsive in his home. Family reports he has been sick with the flu and has not been eating well. His skin is pale and diaphoretic. Blood glucose reads 38 mg/dL. The patient cannot swallow safely. What is the MOST appropriate treatment?

8. An 81-year-old woman is found by her daughter lying on the kitchen floor, unable to get up. She states she thinks she fell about 6 hours ago while getting a glass of water. She denies loss of consciousness but says she felt “dizzy” before falling. Her medication list includes: lisinopril, hydrochlorothiazide, metoprolol, warfarin, and oxybutynin. Vital signs are: BP 94/62, HR 58, RR 16, SpO2 94% on room air. Which combination of factors from this scenario most significantly increases her risk of recurrent falls?

9. When providing positive pressure ventilation to an adult patient using a bag-valve-mask (BVM), what is the correct rate and volume?

10. A patient opens her eyes to pain, uses inappropriate words, and withdraws from pain. What is her GCS?

11. A patient appears anxious, is sweating, and has difficulty breathing. What is your immediate concern?

12. A patient with significant blood loss from a traumatic leg injury presents with tachycardia, pale and cool skin, and confusion. Which of these findings is the earliest reliable sign of hemorrhagic shock?

13. You are assessing a 55-year-old male who fell from a ladder. During your primary assessment, you note a deep laceration on his thigh with dark red blood steadily flowing from the wound. His skin is pale and cool, and his radial pulse is rapid at 112 beats per minute. What is your IMMEDIATE priority?

14. What does the “M” in the SAMPLE mnemonic represent?

15. An EMT responds to a call for a patient with chronic pain who frequently uses EMS services. The patient’s pain is not an emergency, but they insist on being transported. The EMT feels frustrated but recognizes an ethical obligation. Which ethical principle MOST directly applies to providing care without judgment in this situation?

16. A 25-year-old male was struck in the right side of the chest with a baseball bat during an altercation. He is alert, breathing with moderate effort, and complains of sharp pain on inspiration. You note bruising and crepitus over ribs 5-8 on the right lateral chest. Based on the mechanism of injury and assessment findings, what associated injury should you be MOST concerned about?

17. Which of the following correctly describes the AVPU scale component where a patient opens their eyes and responds appropriately when you say their name?

18. You respond to a single-vehicle collision on a rural highway at night. As you approach, you note moderate damage to the driver’s side door, a downed power line across the vehicle, and the driver slumped over the steering wheel. There are no other vehicles at the scene. What is your MOST appropriate initial action?

19. What is the correct sequence for the primary assessment?

20. A patient has paradoxical chest wall movement after trauma. What does this indicate?

21. A patient has a respiratory rate of 32 and is using accessory muscles. What does this indicate?

22. A 62-year-old female presents with sudden onset of severe headache followed by vomiting and rapid deterioration in consciousness. She now responds only to painful stimuli with decorticate posturing. Her blood pressure is 220/130 mmHg, and her pulse is 50 beats/min. Her skin is warm and dry. Which combination of findings is MOST concerning and indicates the need for immediate transport?

23. A 22-year-old football player is found unresponsive after a helmet-to-helmet collision during practice. He is not breathing and has no pulse. He is wearing a properly fitted football helmet with a face shield. What is the most appropriate action regarding his helmet?

24. What is the correct dose and concentration of epinephrine for an adult patient (>30 kg) when administered via auto-injector for anaphylaxis?

25. You respond to a construction site where a worker fell 20 feet from a scaffold onto concrete. The patient is conscious and complains of severe back pain. He insists on walking to the ambulance. What is your most appropriate response?

26. During a multi-casualty incident, you hear the following radio exchange: Dispatch: “All units, MVC with multiple patients, Engine 7 on scene requesting two additional ambulances.” Medic 2: “Medic 2 responding from downtown, ETA 8 minutes.” Engine 7: “Engine 7 to Dispatch, we have three patients, one critical, two minor, need one additional BLS unit.” Medic 1: “Medic 1 also available, we can respond from the east side.” Dispatch: “Medic 1, return to your station, you’re not requested on this call.” Medic 2: “Medic 2, what’s the exact location?” Which communication errors occurred during this exchange?

27. You are dispatched to a “psychiatric emergency” at a private residence. Dispatch reports that the patient is a 28-year-old male with a history of schizophrenia who has been off his medications for two weeks. Family reports he has been “talking to people who aren’t there” and has been “acting paranoid.” While en route, dispatch updates that the patient has armed himself with a kitchen knife and has made threats to “anyone who comes near.” Police are staging nearby. What is your most appropriate response?

28. You arrive on scene of an industrial accident. A worker has been impaled by a metal rod in his right upper thigh. The rod is still in place with minimal external bleeding. The patient is alert, pale, and reports pain at 8/10. His vital signs are: BP 100/68 mmHg, pulse 110 bpm, respirations 20. Which of the following correctly identifies his priority status and appropriate action?

29. A paramedic supervisor notices that EMTs at one station consistently score lower on patient assessment competency during annual evaluations compared to other stations. Which component of the EMS system should address this through targeted training programs?

30. EMS responds to a 58-year-old male with chest pain. Upon arrival, the patient is sitting upright, clutching his chest, with ashen gray skin color. He is diaphoretic and breathing rapidly but can speak in complete sentences. His wife reports he has a history of hypertension and smoked for 30 years. Based on the general impression, which combination of findings MOST strongly suggests a life-threatening condition requiring immediate intervention?

31. You arrive at a scene where a 4-year-old child is unresponsive and not breathing. After confirming no pulse, you begin single-rescuer CPR. What compression depth and ratio should you use?

32. A 66-year-old male with a history of atrial fibrillation complains of sudden onset of right-sided weakness and difficulty speaking. His wife reports the symptoms began about 45 minutes ago. Which additional history question is MOST critical for determining treatment options?

33. You are treating a 64-year-old male with chest pain suggestive of acute coronary syndrome. You have obtained medical direction authorization to assist with aspirin. The patient has his own bottle of 81 mg aspirin tablets. What is the correct dose and administration route?

34. A 6-month-old infant is found unresponsive. The mother reports the baby was fine before naptime. When you assess the infant, you note the infant is limp, cyanotic, and not breathing. You do not feel a pulse. What is the MOST appropriate initial action?

35. A 58-year-old male presents with chest pain that he describes as “crushing” and radiating to his left arm and jaw. He is diaphoretic, nauseated, and appears anxious. Which finding is MOST characteristic of an acute myocardial infarction?

36. You are assessing a 78-year-old female who woke up suddenly at 3 AM with severe shortness of breath. She is sitting upright in bed, appears anxious, and has pink, frothy sputum coming from her mouth. Bilateral crackles are heard on auscultation. Her blood pressure is 168/94 mmHg. What is the most likely diagnosis and appropriate field treatment?

37. Which of the following abbreviations is approved for use in PCR documentation in most EMS systems?

38. You respond to a call for a “person down” at a local park. On arrival, you find a 68-year-old male lying on a bench. He responds to verbal stimuli with incomprehensible sounds. His skin is warm, dry, and pink. His respirations are 16 breaths/min and regular. His radial pulse is present and regular at 76 bpm. Which component of your general impression would be MOST concerning and why?

39. A trauma patient has a seat belt sign across the abdomen. What injuries should you anticipate?

40. You respond to a motor vehicle collision where a 17-year-old male was driving. He appears emancipated—he states he lives alone, works full-time, and pays his own bills. He has a fractured femur and requires transport. He refuses treatment. Which statement BEST describes your legal obligation?

41. You are called to a residence for a 62-year-old male with altered mental status. Upon arrival, his wife states he has a history of seizures and was found on the floor this morning unresponsive. Your primary assessment reveals: he is unresponsive to voice and pain, his airway is open, breathing is shallow at 8 breaths per minute, radial pulse is 88 and regular. His skin is pale and dry. You note dried blood on his tongue and bruising on his face consistent with a fall. You attempt to insert an oropharyngeal airway, but he gags when it contacts his posterior pharynx. What is the MOST appropriate action?

42. According to the pulse-blood pressure correlation taught in EMT courses, what is the minimum estimated systolic blood pressure if a patient has a palpable radial pulse?

43. You are dispatched to a 26-year-old female, 34 weeks pregnant, who was the restrained driver in a moderate-speed motor vehicle collision. During your primary assessment, she complains of abdominal pain and appears anxious. Her vital signs are: BP 100/70 mmHg, HR 108 bpm, RR 22, SpO2 96%. She has a contusion across her lower abdomen from the seatbelt. While her vital signs are stable, why is this patient considered a priority?

44. When assessing a patient’s level of consciousness using the AVPU scale, what does the “V” represent?

45. You respond to a 28-year-old male who crashed his motorcycle. During your primary assessment, you cannot palpate a radial pulse but can feel a weak carotid pulse. His skin is pale, cool, and clammy. What is the significance of the absent radial pulse with present carotid pulse?

46. You respond to a “person down” call at a shopping mall. When you arrive, you find a 45-year-old male lying on the floor. Bystanders report he suddenly collapsed while walking. Your primary assessment reveals: he is unresponsive to voice and pain, has snoring respirations at 8 breaths per minute, his skin is flushed and warm, and his radial pulse is strong at 68 beats per minute. Based on your general impression and primary assessment, what is the MOST likely underlying problem?

47. Which of the following vital sign changes indicates a patient has transitioned from compensated to decompensated shock?

48. A 67-year-old male with a history of COPD complains of shortness of breath. During your primary assessment, you note he is able to speak in full sentences, has a respiratory rate of 24 breaths per minute, oxygen saturation of 92% on room air, and bilateral wheezing. Should this patient be categorized as a priority patient?

49. You are dispatched to a 71-year-old male with COPD who is having difficulty breathing. Family reports he has been using his home oxygen concentrator at 4 L/min. The patient appears cyanotic and is breathing 8 times per minute with minimal chest rise. What is the most appropriate oxygen therapy for this patient?

50. A 52-year-old male complains of chest pain. When asked what makes the pain worse, he reports that taking a deep breath significantly increases the discomfort. Which OPQRST component does this response address?

51. You arrive at a residence for a patient with difficulty breathing. The patient is alert but struggling to speak in full sentences, has audible wheezing, and is using accessory muscles. Oxygen saturation is 88% on room air. Which resource should you request while preparing for transport?

52. A 71-year-old female has sudden onset of right-sided weakness and difficulty speaking. Her husband notes the symptoms started about 2 hours ago. Blood pressure is 168/94, blood glucose is 95 mg/dL. What should you do?

53. An EMT responds to a residence for a “sick person.” Upon entering, the EMT observes a 58-year-old woman sitting upright in bed, appearing anxious. Her skin is cool and diaphoretic, and she is using accessory muscles to breathe. She tries to answer questions but can only manage one or two words before gasping. Her husband reports she has a history of congestive heart failure. Based on this general impression and the patient’s presentation, what is the MOST appropriate interpretation and initial action?

54. What is the role of EMS personnel at a HazMat incident before decontamination is complete?

55. You are called to a residence for a 34-year-old male with cough and fever. He recently returned from international travel. As you approach, you observe the patient is wearing a surgical mask and mentions his sister was diagnosed with tuberculosis last week. What PPE is most appropriate?

56. You are assessing a 78-year-old female who lives alone. Her daughter called 911 because her mother has been “acting confused” for the past two days. The patient denies any pain or discomfort. Her vital signs are: BP 98/62 mmHg, HR 102/min, RR 24/min, SpO2 94% on room air. She is afebrile. What is the most likely cause of her altered mental status?

57. You arrive at a scene with significant background noise from construction equipment. The patient is a 72-year-old female with difficulty breathing. You need to call in a radio report to the receiving hospital. What is the BEST approach to ensure effective communication?

58. You respond to a motor vehicle collision. A 35-year-old male was the unrestrained driver. He is walking around the scene, talking on his phone, and tells you “I’m fine, just a little shaken up.” You observe a small laceration on his forehead. What should your general impression tell you?

59. A 28-year-old male was found unresponsive by friends who report he may have taken several opioid pills. His respirations are 6 breaths/min and shallow. His pupils are pinpoint (1 mm bilaterally). What is the MOST appropriate treatment?

60. You arrive at a motor vehicle collision and find three patients. Patient A is walking around complaining of neck pain. Patient B is sitting on the curb with a deformed left forearm. Patient C is unconscious, lying on the ground with rapid, shallow breathing and a weak, thready pulse. Which patient should receive your immediate attention?

61. Which of the following findings during your general impression would MOST strongly indicate a patient is “sick” and requires immediate intervention?

62. You are assessing a 45-year-old male who complains of feeling “weak and dizzy.” During your primary assessment, you note his skin is pale, cool, and diaphoretic. His radial pulse is weak and rapid at 118 beats per minute. What do these findings indicate about his circulatory status?

63. A patient has suffered a significant blunt neck injury. What airway concern should you have?

64. During a secondary assessment physical examination, which technique should generally be performed FIRST for each body region?

65. You are called to care for a 45-year-old male with a productive cough, fever, and neck stiffness. The patient is alert but appears ill. Which combination of PPE is most appropriate for this encounter?

66. Using the JumpSTART pediatric triage system, you encounter a 5-year-old child who is not breathing. What should you do FIRST?

67. A 62-year-old female with a history of congestive heart failure presents with sudden onset of difficulty breathing that woke her from sleep. She is sitting on the edge of her bed, appears anxious, and is using accessory muscles to breathe. Her skin is pale, cool, and diaphoretic. She can only speak one or two words at a time. What is your general impression, and what does it indicate about her clinical status?

68. You are dispatched to a residence for a 72-year-old male with altered mental status. The family reports he was “fine this morning” but has become progressively more confused over the past 6 hours. On assessment, he does not respond to his name being called loudly. When you apply a sternal rub, he extends both arms and legs rigidly with internal rotation of his wrists. His respirations are irregular at 10 per minute. His blood glucose is 118 mg/dL. What is the MOST accurate interpretation of his AVPU status and neurological findings?

69. A 55-year-old male collapses while shoveling snow. Bystanders state he grabbed his chest and fell. You arrive to find him unresponsive, apneic, and pulseless. CPR is initiated, and the AED advises a shock. After the shock, you immediately resume compressions. After 2 minutes, the AED reanalyzes and again advises a shock. You deliver the second shock and resume compressions. The patient remains in cardiac arrest. Which reversible cause should you MOST suspect based on the circumstances?

70. You are dispatched to a chemical plant for a worker who collapsed near a storage tank. Several other workers appear ill, and there is a strong odor in the air. What is your MOST appropriate initial action?

71. You are dispatched to a possible overdose. A 22-year-old male is found in his bedroom by his mother. Assessment reveals: unresponsive to all stimuli (voice, touch, pain), respiratory rate 8 with shallow tidal volume, pulse 52, blood pressure 88/54, skin pale and cool, and pupils 2mm and reactive. His mother reports he has been depressed recently and she found an empty bottle of “nerve pills” on his nightstand. Based on the primary assessment findings, what is the MOST likely cause of his presentation, and what is your immediate management priority?

72. When assessing blood pressure in an adult patient, the Korotkoff sounds during auscultation represent which physiological event?

73. A 72-year-old male with a history of severe COPD presents with increasing shortness of breath. His SpO2 is 88% on room air. He appears anxious and is using accessory muscles. Which of the following is the MOST appropriate oxygen administration strategy?

74. You are dispatched to an industrial warehouse for a reported chemical spill with multiple patients experiencing respiratory distress. Upon arrival, you observe several workers coughing and holding their throats near a cloud of unknown vapor. What is your most appropriate initial action?

75. During a secondary assessment of an unconscious patient, the EMT notes that the pupils are unequal in size. The right pupil is 4mm and reactive to light; the left pupil is 6mm and fixed (non-reactive). This finding MOST strongly suggests:

76. You respond to a residence where a 58-year-old male is complaining of “not feeling well” for the past two days. On your general impression, you note he appears ill, is diaphoretic, and is sitting in a tripod position. His wife states he has a history of diabetes and “heart problems.” When you ask him what’s wrong, he responds with one-word answers in a soft voice. Analyze this general impression and determine which combination of findings most strongly suggests a high-priority condition requiring immediate intervention.

77. A 55-year-old female with a history of hypertension and diabetes presents with sudden onset of severe back pain that radiates to her abdomen. She describes it as “tearing” pain. Her blood pressure is 180/110 mmHg in her right arm and 145/95 mmHg in her left arm. Her pulses are asymmetric, with a diminished femoral pulse on the left side. What is the MOST concerning possible diagnosis, and how does it explain the findings?

78. A 67-year-old male reports crushing substernal chest pain. When asked if the pain spreads anywhere, he points to his left arm and jaw. This radiation pattern is MOST consistent with which condition?

79. After caring for a patient with suspected COVID-19, you are removing your PPE. Which of the following represents the correct sequence for doffing your equipment?

80. Which behavior BEST demonstrates professional conduct by an EMT at the scene of an emergency?

81. A 22-year-old male was involved in a motorcycle crash. He has an open femur fracture on his right leg with active bleeding, a deformed left wrist, and abrasions on his face. He is awake but anxious. His vital signs are BP 100/70, HR 118, RR 24. Which intervention should be prioritized first?

82. You respond to a 22-year-old male with a deep laceration to his forearm from broken glass. Bright red blood is spurting from the wound. During your primary assessment, you note his skin is pale and diaphoretic, with a heart rate of 112. What is the MOST appropriate immediate intervention?

83. You respond to an industrial warehouse for an unresponsive worker. Upon arrival, you observe an overturned chemical drum with a diamond-shaped placard showing the number 3 in a red quadrant. A strong chemical odor is present, and you notice a visible vapor near the floor. Several employees are attempting to drag the patient toward the exit. What is your MOST appropriate action?

84. You respond to a residential structure fire where firefighters are actively working to extinguish flames. Command reports that one occupant was rescued from a second-floor bedroom. The patient is a 58-year-old female with singed nasal hairs, carbonaceous sputum, and facial burns. She is coughing and reports hoarseness. Which resource should you request immediately in addition to routine ALS transport?

85. During a mass casualty incident, you are triaging patients. You encounter a 28-year-old male with an open femur fracture and bright red blood spurting from the wound. He is conscious and follows commands. His radial pulse is present but rapid and weak. How should this patient be categorized?

86. When communicating with the receiving hospital, you should provide all of the following information EXCEPT:

87. Your unit arrives at the scene of a reported assault. You see police vehicles but no officers are visible outside. A man is lying motionless on the ground near an open doorway. What is your most appropriate action?

88. A 54-year-old female with a history of diabetes is found unresponsive in her bedroom. Her skin is pale, cool, and diaphoretic. Her pulse is rapid and thready. What is the MOST likely cause of her presentation?

89. Which of the following is the most common atypical presentation of acute myocardial infarction in geriatric patients?

90. You respond to a two-vehicle collision. Upon arrival, you find two patients. Patient A is a 45-year-old driver of the first vehicle, ambulatory at the scene, with a small laceration on his forehead. Patient B is the driver of the second vehicle, still seated behind the wheel, holding her chest and complaining of difficulty breathing. Her skin is pale and diaphoretic. Which patient should be assessed FIRST?

91. A 52-year-old female is found unresponsive in her home. During your primary assessment, you note she has snoring respirations at 8 breaths per minute. Her chest rise is minimally visible. What is your FIRST action?

92. Dispatch sends you to a 55-year-old male with chest pain at a construction site. Upon arrival, workers direct you to a man lying at the bottom of a 12-foot excavation trench. He is clutching his chest and appears diaphoretic. One worker mentions the patient was complaining of chest pain before climbing down to check a pipe. Analyze the situation and determine the most appropriate response.

93. You respond to a residence for a 16-year-old female with abdominal pain. She tells you privately that she is pregnant but begs you not to tell her parents, who are unaware. Her parents arrive on scene and demand to know what is wrong with their daughter. She is alert, oriented, and otherwise stable. What is your BEST course of action regarding disclosure and documentation?

94. After treating a patient with active tuberculosis, an EMT must remove their PPE. Which action demonstrates proper doffing technique?

95. You are treating two diabetic patients simultaneously. Patient A has blood glucose of 52 mg/dL with cool, clammy skin and confusion that developed over 30 minutes. Patient B has blood glucose of 425 mg/dL with warm, dry skin, Kussmaul respirations, and confusion that developed over 2 days. Based on the pathophysiology of each condition, which statement BEST explains the difference in their skin presentations?

96. Which piece of personal protective equipment (PPE) should be donned FIRST when preparing for patient contact with potential bloodborne pathogen exposure?

97. What does the “P” represent in the AVPU scale used during the primary assessment?

98. A 67-year-old female presents with chest pain and difficulty breathing. During your primary assessment, you note her skin is cool, pale, and diaphoretic. Her radial pulse is weak and rapid at 118 beats per minute. She is alert but anxious. What is your primary assessment interpretation of her circulatory status?

99. You are assessing a 45-year-old male who is unresponsive. He has snoring respirations and his airway appears partially obstructed by his tongue. He does not gag when you insert an OPA. What should you do?

100. You respond to a homeless shelter for a patient with a chronic cough who reports night sweats and unintentional weight loss over the past month. He has never been tested for tuberculosis. Several other shelter residents are nearby, and one staff member is trying to help the patient stand. The scene is indoors with limited ventilation. Analyze the situation and identify the MOST appropriate immediate action.