A conscious and anxious adult is found in the driver’s seat after a left sided impact MVC. The pt. is complaining of pain in the left upper quadrant (LUQ) that radiates to the left shoulder. Pt. also reports nausea, and “feeling cold.” Breath sounds are clear bilaterally. A contusion is present over the left lateral chest wall, the abdomen is rigid with LUQ guarding, and bowel sounds are diminished. All extremities move to command. There is no blood at the urinary meatus and no scrotal edema or bruising. VS: BP 92/78, P 124, R 32, SpO2 93%; EtCO2 26; skin is cool, pale, and moist. Pupils are bilaterally dilated, equal and reactive to light.Which of these is likely?

(2 of 2)EMS is dispatched to a structure collapse with reports of extensive rubble containing bricks, timber and concrete. Traffic is mild, skies are clear, weather is warm and roads are dry. There is no indication on the number of patients. You are currently responding as one ambulance that is staffed with 2 paramedics. A non-level 1 community hospital is 5 minutes by ground and a level 1 trauma is 12 minutes by ground. What should EMS do if the search, rescue and extrication results in an extended scene time?

What is meant by the “2 patient’s per hospital” protocol in multiple patient incidents? 

(5 of 7)SceneEMS is dispatched at 0330 to a highway site following a 10-vehicle crash. Multiple patients are present. Weather is 14° F, skies are dark, traffic is light and roads are icy. A badly deformed vehicle has two patients inside, one adult driver and one child passenger. They are both unconscious and not breathing.Using primary START triage, what action is indicated first for both patients?

(11 of 15)SceneEMS is dispatched at 0100 to a forest preserve for an ATV crash. Response time is 10-15 minutes. You are traveling on poorly lit paved road that leads to a clear opening to the trail. It is a cool fall evening; weather is 40°F. Skies are clear, roads are dry, traffic light. Ambulance is staffed with 2 paramedics and a BLS engine. Your nearest community hospital is 12 minutes ETA by ground and a level 1 trauma center is 25 minutes by ground.Dispatch informs you that a park ranger has arrived on scene. It is confirmed that one patient was injured after being ejected from the ATV. There is a large group of college aged students present and there is evidence of alcohol consumption at the scene. The paved road leading to the opening of the trail is clear and unobstructed. The trail leading to the patient is on rocky and uneven ground.You and your crew are led to the location of the patient with the help of the park ranger. The ATV is several feet away from the patient in the brush and is still running. Pt. presents to be in a lot of pain from an isolated long bone fracture to the right extremity.Patient is a 20-year-old, alert and oriented 4/4. Physical exam finds an angulated deformity to the right humerus, pt. rates it a 10/10 and is in extreme agony. Patient also states “feels like I’m going to vomit.” Pt. states they consumed “1-2 beers” tonight. There are no signs of trauma to the head, or face. The pt. denies numbness, tingling or pain to the back.After removing the patient’s jacket, the right arm presents with a 45° deformity. You see bone protruding through the arm (midshaft of the humerus) with profuse venous bleeding. Pulses are absent distal to the injury. What bleeding control measure should EMS attempt initially?

An adult patient presents with bowel protruding from an open abdominal wound. BP: 80/60 and HR: 120. Which of these is the most acute concern for EMS to consider?

(12 of 15) Post-Scene EMS is dispatched at 0100 to a forest preserve for an ATV crash. Response time is 10-15 minutes. You are traveling on poorly lit paved road that leads to a clear opening to the trail. It is a cool fall evening; weather is 40°F. Skies are clear, roads are dry, traffic light. Ambulance is staffed with 2 paramedics and a BLS engine. Your nearest community hospital is 12 minutes ETA by ground and a level 1 trauma center is 25 minutes by ground.Dispatch informs you that a park ranger has arrived on scene. It is confirmed that one patient was injured after being ejected from the ATV. There is a large group of college aged students present and there is evidence of alcohol consumption at the scene. The paved road leading to the opening of the trail is clear and unobstructed. The trail leading to the patient is on rocky and uneven ground.You and your crew are led to the location of the patient with the help of the park ranger. The ATV is several feet away from the patient in the brush and is still running. Pt. presents to be in a lot of pain from an isolated long bone fracture to the right extremity.Patient is a 20-year-old, alert and oriented 4/4. Physical exam finds an angulated deformity to the right humerus, pt. rates it a 10/10 and is in extreme agony. Patient also states “feels like I’m going to vomit.” Pt. states they consumed “1-2 beers” tonight. There are no signs of trauma to the head, or face. The pt. denies numbness, tingling or pain to the back.After removing the patient’s jacket, the right arm presents with a 45° deformity. You see bone protruding through the arm (midshaft of the humerus) with profuse venous bleeding. Pulses are absent distal to the injury. While performing a detailed secondary exam, the patient reports feeling pain to the right lower leg. He describes that the outside of his lower pant leg got caught on the wheel, causing him to lose control of the steering and part of his leg came in contact with a hot spot on the ATV. Assessment finds a partial and full thickness burn to the anterior and lateral aspects of the lower right leg, below the level of the calf, estimating 2% TBSA using the rule of palms.  Select 2 options: {B7CE4EEF-775C-4230-B751-A021F30153CC}.png

What are the primary role(s) of the Medical Branch of the Operations Division in the Incident Command System (ICS)?

(15 of 15)   Post-Scene   EMS is dispatched at 0100 to a forest preserve for an ATV crash. Response time is 10-15 minutes. You are traveling on poorly lit paved road that leads to a clear opening to the trail. It is a cool fall evening; weather is 40°F. Skies are clear, roads are dry, traffic light. Ambulance is staffed with 2 paramedics and a BLS engine. Your nearest community hospital is 12 minutes ETA by ground and a level 1 trauma center is 25 minutes by ground.Dispatch informs you that a park ranger has arrived on scene. It is confirmed that one patient was injured after being ejected from the ATV. There is a large group of college aged students present and there is evidence of alcohol consumption at the scene. The paved road leading to the opening of the trail is clear and unobstructed. The trail leading to the patient is on rocky and uneven ground.You and your crew are led to the location of the patient with the help of the park ranger. The ATV is several feet away from the patient in the brush and is still running. Pt. presents to be in a lot of pain from an isolated long bone fracture to the right extremity.Patient is a 20-year-old, alert and oriented 4/4. Physical exam finds an angulated deformity to the right humerus, pt. rates it a 10/10 and is in extreme agony. Patient also states “feels like I’m going to vomit.” Pt. states they consumed “1-2 beers” tonight. There are no signs of trauma to the head, or face. The pt. denies numbness, tingling or pain to the back.After removing the patient’s jacket, the right arm presents with a 45° deformity. You see bone protruding through the arm (midshaft of the humerus) with profuse venous bleeding. Pulses are absent distal to the injury. While performing a detailed secondary exam, the patient reports feeling pain to the right lower leg. He describes that the outside of his lower pant leg got caught on the wheel, causing him to lose control of the steering and part of his leg came in contact with a hot spot on the ATV. Assessment finds a partial and full thickness burn to the anterior and lateral aspects of the lower right leg, below the level of the calf, estimating 2% TBSA using the rule of palms. Vitals indicate the patient is hemodynamically stable. Prior to transport, the pt’s extremity was splinted in neutral alignment. A faint distal pulse to the injured arm returns. Bleeding control measures are effective. Patient received an opioid for pain and transport is initiated. 5 minutes into transport, the patient’s pain has not changed from before. Pt. remains hemodynamically stable. Blood glucose is 200.    There is 5 minutes remaining in the transport when the patient loses a pulse in the injured right arm that was splinted. You should:

Which of these is a sign of peritonitis?