Nremt Aemt Level Quiz: Lifting Moving And Patient Transport

What this quiz covers

This quiz focuses on Lifting Moving And Patient Transport, giving you a quick way to practice the rules, question types, and explanations that matter most for Nremt Aemt Level.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

Question 1

1. Apply four-point hard restraints immediately to prevent potential escalation.
2. Use de-escalation techniques and have a police officer ride in the ambulance. (correct answer)
3. Request chemical sedation from medical control prior to attempting to move the patient.
4. Refuse transport unless the patient is placed in full police custody and handcuffs.

Explanation: The principle of using the least restrictive means necessary applies. Since the patient is not physically violent, verbal de-escalation is the primary strategy. Having law enforcement present in the patient compartment provides an added layer of safety without resorting to premature physical or chemical restraint. Restraints should only be used if de-escalation fails and the patient becomes a danger to themselves or others.

Question 2

1. Advise your partner to complete the transport and file an injury report after the call.
2. Request a supervisor and an additional crew to the scene to take over patient care. (correct answer)
3. Have your partner remain in the driver's seat and manage patient care by yourself.
4. Tell your partner to take a short break while you finish securing the patient for transport.

Explanation: Any potential provider injury, especially a back injury, compromises the crew's ability to safely care for the patient and operate the ambulance. The immediate priority is to ensure the safety of the crew and continuity of patient care. This requires notifying a supervisor and requesting another unit to either assist or take over the transport, allowing the injured partner to be evaluated.

Question 3

1. Use a draw sheet to slide her from the recliner onto a scoop stretcher. (correct answer)
2. Perform a direct ground lift with two providers to place her on the cot.
3. Assist the patient to a standing position and pivot her to the cot.
4. Use an extremity lift, with one rescuer at the head and another at the knees.

Explanation: For a frail patient with painful joints and spinal deformity, minimizing movement is key. A scoop stretcher, used in combination with a draw sheet, allows the patient to be lifted with very little manipulation of her spine or limbs. An extremity lift could be painful, a direct lift is difficult from a chair, and she is unable to bear weight, making a stand-and-pivot impossible.

Question 4

1. Place a non-rebreather mask set to 15 lpm on the patient over their surgical mask.
2. Ensure the patient compartment's exhaust fan is activated and set to high. (correct answer)
3. Wear a surgical mask yourself to prevent droplet transmission during the transport.
4. Wipe down all surfaces the patient may have touched with a disinfectant wipe.

Explanation: For airborne diseases like tuberculosis, engineering controls are a primary line of defense. Activating the ambulance's exhaust fan to create negative pressure in the patient compartment helps to vent potentially infectious particles outside, reducing the concentration of aerosols within the vehicle and minimizing exposure risk for the provider. While personal protective equipment (an N95 respirator, not a surgical mask) is also crucial, ventilating the space is the key operational step being tested here.

Question 5

1. Place her in a Trendelenburg position to increase blood flow to the brain.
2. Manually displace the uterus to the left side while she remains supine.
3. Position her in a semi-Fowler's position to reduce pressure on the diaphragm.
4. Place her in a left lateral recumbent position or tilt the backboard 15-30 degrees to the left. (correct answer)

Explanation: The patient is likely experiencing supine hypotensive syndrome, where the gravid uterus compresses the inferior vena cava, reducing venous return to the heart. The standard of care is to position the patient on her left side or, if immobilized, tilt the entire backboard to the left. This displaces the uterus off the vena cava and should improve her blood pressure and symptoms.

Question 6

1. Two providers should be on one side of the bed, with the third provider on the opposite side.
2. All three providers should position themselves on the same side of the bed to pull the patient.
3. One provider at the head, one at the feet, and one at the side to guide the patient.
4. The two strongest providers should be at the patient's head and chest, with the third at the feet. (correct answer)

Explanation: The weight of a patient is not distributed evenly. The head, torso, and pelvis account for the majority of the weight. To ensure a balanced and safe lift, the strongest providers should be positioned at the head and chest area where the greatest load is concentrated. Placing personnel unevenly on the sides can lead to twisting motions and injury.

Question 7

1. Ensuring the pressure bag remains inflated to exactly 300 mmHg at all times.
2. Positioning the fluid bag below the level of the patient's heart to assist with flow.
3. Protecting the IO site from being bumped and securing the tubing to prevent dislodgement. (correct answer)
4. Pausing the infusion during the move to prevent fluid overload from jostling.

Explanation: The primary concern when moving any patient with IV or IO access is securing the site and tubing. Dislodgement of an IO catheter is difficult to correct and would interrupt a critical fluid resuscitation. While pressure is important for flow, the physical security of the device is the most critical consideration during the physical act of moving the patient.

Question 8

1. A non-urgent move, after a full secondary assessment is completed on scene.
2. An emergency move, performed before any assessment or treatment is initiated. (correct answer)
3. An urgent move, performed after assessing the ABCs and addressing any life-threats.
4. A standard lift, once the fire department has ventilated and cleared the structure.

Explanation: An emergency move is indicated when there is an immediate, ongoing danger to the patient or responders. An active carbon monoxide leak with a symptomatic patient constitutes such a danger. The patient must be moved to a safe environment before any significant assessment or treatment can take place. Waiting to perform assessments or for the scene to be cleared would cause unnecessary and harmful delay.

Question 9

1. Tilt the head of the flexible stretcher downwards to allow for drainage.
2. Continue the extrication quickly and suction the patient once in a larger space.
3. Turn the patient's head to the side and use a suction catheter immediately. (correct answer)
4. Use the stretcher's flexibility to bend the patient into a semi-Fowler's position.

Explanation: A flexible stretcher offers limited ability to reposition the entire patient, but the head can still be turned. The immediate priority is to prevent aspiration. Turning the head to the side uses gravity to help clear the oropharynx, and suction should be used concurrently to remove the vomitus. Delaying airway management is inappropriate.

Question 10

1. Elevating the injured leg above the heart to minimize swelling and pain.
2. Ensuring the splint is tight enough to prevent any movement during transport.
3. Applying cold packs to the injury site to reduce inflammation and bleeding.
4. Covering the patient with blankets and increasing the ambulance's cabin temperature. (correct answer)

Explanation: Trauma patients, especially those with significant fractures and bleeding, are at high risk for hypothermia. Hypothermia worsens coagulopathy, leading to more bleeding and shock (the 'trauma triad of death'). Preventing heat loss by covering the patient and warming the ambulance is a critical intervention to prevent this cascade, even more so than limb elevation or local cold therapy in the initial phase.

Question 11

1. Stop at a safe distance from the tracks and wait for the train to pass before proceeding. (correct answer)
2. Notify dispatch that you will be delayed and request an alternate route.
3. Activate your siren and carefully proceed through the crossing against the signals.
4. Turn off the road, find a place to bypass the gate, and cross the tracks quickly.

Explanation: Safety is the paramount concern during ambulance operations. Railroad crossings are extremely dangerous. The only correct action is to obey all traffic signals and warning devices, stopping at a safe distance and waiting for the train to pass. Even in an emergency vehicle, attempting to cross against the signals is a violation of traffic laws and poses an unacceptable risk to the crew, the patient, and the public.

Question 12

1. Request air medical transport due to the significant mechanism and prolonged ground transport time. (correct answer)
2. Initiate immediate ground transport to avoid the delay of waiting for the helicopter to arrive.
3. Splint the femur and begin ground transport, requesting the helicopter to intercept you en route.
4. Contact medical control to have them decide between air and ground transport for this patient.

Explanation: Air medical transport is indicated by the prolonged ground transport time, significant mechanism of injury, and altered mental status. The total time to the trauma center via air (20 min wait + 15 min flight = 35 min) is significantly less than ground transport (75 min). While waiting for the helicopter seems like a delay, it results in much faster delivery to definitive care.

Question 13

1. Remove the child from the car seat and secure them to the ambulance cot with standard straps.
2. Place the child on their parent's lap and use the cot seatbelt to secure them both.
3. Transport the child in their own undamaged car seat, securing it appropriately to the ambulance cot. (correct answer)
4. Immobilize the child on a long spine board as a precaution due to the mechanism of injury.

Explanation: For an uninjured or mildly injured child, the safest way to transport them in an ambulance is to use their own car seat, provided it is not damaged. The car seat should be secured to the cot following the manufacturer's recommendations and ambulance service protocols. This provides superior restraint compared to standard cot straps, which are not designed for small children.

Question 14

1. Continue moving rapidly to the ambulance where airway equipment is more accessible.
2. Stop movement on the stairs, begin bag-valve-mask ventilations, and prepare for CPR.
3. Stop movement, move the patient to the nearest flat surface, and manage the airway. (correct answer)
4. Place an oropharyngeal airway and continue moving while your partner prepares the BVM.

Explanation: A stairwell is an unsafe location to manage a critical patient. The immediate priority is to move the patient out of the hazardous position (the stairs) to a flat surface (like a landing or the bottom of the stairs). Once on a stable surface, the airway can be properly assessed and managed. Continuing movement or attempting complex interventions on the stairs is unsafe and ineffective.

Question 15

1. Utilize a stair chair, as it is designed for navigating tight stairwells and conserving space.
2. Request a bariatric ambulance and a lift-assist team to perform a carry using a bariatric tarp. (correct answer)
3. Administer high-flow oxygen and assist the patient in walking slowly down the stairs with crew support.
4. Move the patient to a bariatric stretcher and attempt to maneuver it down the stairs with maximum manpower.

Explanation: The patient's bariatric status, severe respiratory distress, and the challenging environment necessitate specialized resources. A bariatric tarp and a lift-assist team are designed for this type of situation, ensuring both patient and provider safety. Attempting to use standard equipment or forcing the patient to ambulate would be unsafe.

Question 16

1. Suction the airway and continue transport without altering the patient's position to maintain immobilization.
2. Log roll the patient and the entire backboard to the side to allow for drainage while maintaining spinal alignment. (correct answer)
3. Sit the patient up to a semi-Fowler's position to prevent aspiration while continuing ventilations.
4. Remove the cervical collar and backboard immediately to gain better access to the patient's airway.

Explanation: The primary concern is airway patency and preventing aspiration, but this must be balanced with maintaining spinal motion restriction. The correct procedure is to log roll the entire unit (patient and board) onto its side, allowing gravity to clear the airway. Suctioning alone may not be sufficient, and changing the patient's position or removing immobilization is contraindicated.

Question 17

1. A position of comfort, allowing the patient to assume any posture that is tolerable.
2. Supine with the head elevated 30 degrees to decrease intracranial pressure. (correct answer)
3. Left lateral recumbent position to reduce the risk of aspiration if vomiting occurs.
4. Trendelenburg position to maximize cerebral perfusion and blood pressure.

Explanation: Post-cardiac arrest care includes measures to protect the brain from secondary injury. Elevating the head of the bed to 30 degrees can help reduce intracranial pressure and may improve cerebral venous outflow without compromising cerebral perfusion pressure. The airway is secured with an advanced device, making aspiration less of a concern than cerebral edema. Trendelenburg is not recommended and can worsen ICP.

Question 18

1. Transport to the closest hospital for stabilization before transfer to the cardiac center.
2. Contact medical control to request air medical transport to the cardiac center.
3. Transport directly to the cardiac center, notifying them of a 'STEMI alert' en route. (correct answer)
4. Allow the patient to choose the destination after explaining the capabilities of each facility.

Explanation: For patients with a clear ST-elevation myocardial infarction (STEMI), the primary goal is rapid reperfusion, which is best achieved at a facility with a cardiac catheterization lab. Guidelines recommend bypassing closer hospitals without PCI capability to go directly to a cardiac center, provided the transport time is reasonable (e.g., less than 90 minutes from first medical contact to balloon).

Question 19

1. Use the draw sheet method, with at least four people to slide the patient and board over. (correct answer)
2. Remove the straps and have the patient carefully roll themselves onto the hospital bed.
3. Lower your cot and have the hospital staff lift the patient off the backboard onto their bed.
4. Undo the straps from one side and tilt the backboard to slide the patient onto the bed.

Explanation: The safest and most controlled way to move an immobilized patient from one surface to another is a coordinated slide using a draw sheet. This requires sufficient personnel (at least four: two on each side) to ensure the patient and board are moved as a single unit, minimizing any jostling or potential for further injury. All other methods risk compromising spinal immobilization.

Question 20

1. A scoop stretcher, to minimize movement of the pelvis during the lift. (correct answer)
2. A long spine board, to ensure full body immobilization due to the mechanism of injury.
3. An extremity lift performed by two providers to directly place her on the cot.
4. A flexible stretcher (Reeves), as it is the most comfortable for elderly patients.

Explanation: A scoop stretcher is the ideal device for suspected hip or pelvic fractures. It allows the patient to be lifted with minimal movement by securing them from both sides, effectively 'scooping' them up. This reduces pain and the risk of further injury. A long spine board is no longer indicated for isolated pelvic injuries, and a direct lift would cause excessive, painful movement.