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10 free EMT practice questions: Transport Decision (Rapid vs. Focused)

These are real questions from the same bank the app draws from. Each one is written to the NREMT EMT content specifications and kept inside the EMT scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

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Question 1 of 10

A 45-year-old patient is alert and oriented. Skin is pale and cool to the touch, heart rate is 118/min, and blood pressure is 88/56 mmHg. Respiratory rate is 22/min. The patient reports feeling dizzy when standing 5 minutes ago but denies any obvious bleeding. Which transport decision is most appropriate?

Show the answer and rationale

Correct answer · Immediately load the patient and provide rapid transport to the nearest appropriate facility

This patient is in shock and needs rapid transport now. The blood pressure is 88/56, the heart rate is 118, and the skin is pale and cool. A blood pressure of 88/56 means the patient has moved past simple compensation into hypotension. The pale, cool skin comes from the vessels in the skin tightening to push blood to the core. The respiratory rate of 22 is part of the same compensation. Perfusion to the cells is already failing, not just at risk. What matters now is getting the patient to a facility that can treat the cause of the shock. Do the rest of your assessment and give oxygen on the way.

Why the others are wrong

Perform a focused assessment on the lower extremities and transport non-emergently: Pale, cool skin, a heart rate of 118, and a blood pressure of 88/56 mean this patient is in shock. A shock patient goes emergent, and the rest of the assessment happens on the way.

Perform a complete secondary assessment at the scene before transport: The primary assessment here already found shock, with a heart rate of 118 and a pressure of 88/56. The secondary assessment can happen in the moving ambulance, and doing it on scene holds up transport.

Place the patient on high-flow oxygen and reassess vitals in 5 minutes before deciding on transport mode: Waiting five minutes on scene spends time this patient does not have. A pressure of 88/56 with a heart rate of 118 already shows shock. Give the high-flow oxygen on the way.

Question 2 of 10

A 68-year-old patient is found unresponsive in the bedroom by family. The scene is safe. On primary assessment, the airway is patent and breathing is adequate at 14/min with good air movement. Skin is warm and dry. Vital signs: P 72/min, BP 130/76 mmHg, SpO₂ 97% on room air. Which transport decision is most appropriate?

Show the answer and rationale

Correct answer · Rapid transport; unresponsiveness is a life threat regardless of vital sign stability

Unresponsiveness is a life threat on its own. You make the transport decision from the primary assessment. The primary assessment looks for life threats in the airway, breathing, circulation, and mental status. This patient fails on mental status. The pulse of 72, the blood pressure of 130/76, the saturation of 97%, and breathing at 14 are all normal. Normal numbers mean the body is holding up right now. They say nothing about why the brain is not working. An unresponsive patient also cannot protect their own airway. Position the patient, keep suction ready, and go. Stroke, bleeding in the brain, low blood sugar, overdose, a post-ictal state, and sepsis can all cause unresponsiveness. Every one of them needs a hospital quickly.

Why the others are wrong

Non-urgent transport; stable vital signs indicate a minor event: Stable vital signs do not make this a minor event, because this patient is unresponsive. Unresponsiveness means the primary assessment already found a problem with mental status. Normal vital signs in an unresponsive patient show how much reserve is left, not how serious the problem is.

Focused assessment at the scene; transport only if vitals become abnormal: Waiting for the vital signs to turn abnormal means waiting for the body to stop compensating. By then it is the last moment you can act, and outcomes are worst. The focused assessment comes after the life threats are handled, so do it en route, not on scene.

Begin supplemental oxygen and reassess; transport urgently only if the patient regains consciousness: Most of the causes of unresponsiveness do not get better on the bedroom floor. Waiting for the patient to wake up before you transport urgently keeps an unresponsive patient on scene too long.

Question 3 of 10

A 68-year-old patient is found by the patient's daughter unable to speak clearly. The daughter states the patient was well 30 minutes ago. The patient is alert but confused, with obvious slurred speech and drooling. On examination, there is facial asymmetry with drooping on the right side, and the right arm drifts downward when held against gravity. Vital signs: P 82/min, R 16/min, BP 158/92 mmHg, skin warm and dry. Which transport decision is most appropriate?

Show the answer and rationale

Correct answer · Perform primary assessment and rapid transport to the nearest appropriate facility; reassess en route

This patient is having a stroke. The daughter says the patient was normal 30 minutes ago. Normal 30 minutes ago puts this patient inside the treatment window. The hospital can still give clot busting drugs, called fibrinolytics, or pull the clot out with a procedure called a thrombectomy. The patient also has the FAST findings: facial droop on the right, the right arm drifting down, and slurred speech. The T in FAST is the time the patient was last known well. In a stroke, a blocked or bleeding blood vessel in the brain cuts off oxygen to the brain cells. The brain tissue around the damage can still be saved if blood flow comes back quickly. Every minute on scene uses up that window. Do your primary assessment, transport fast to a facility that can treat stroke, and reassess on the way.

Why the others are wrong

Perform a complete secondary assessment and detailed neurological exam at the scene: The facial droop, slurred speech, and arm drift already make the FAST screen positive. A detailed exam adds nothing that would change your transport decision, and it uses up minutes this patient cannot get back.

Obtain baseline vital signs and repeat assessment every 5 minutes at the scene: With a known onset 30 minutes ago, the treatment window is already running. Repeating vitals on scene every 5 minutes uses up that window. Recheck the vitals en route instead.

Contact medical control for guidance before deciding whether rapid transport is necessary: You do not need permission to transport this patient, because the FAST findings already meet stroke alert criteria. Calling medical control first only delays you.

Question 4 of 10

An EMT responds for a 34-year-old patient pulled from a backyard pool after being submerged for several minutes. The patient is unresponsive, is breathing 8 times per minute with poor chest rise, and has a weak carotid pulse. Bystanders state the patient waded in from the shallow end and that there was no dive and no fall. The EMT's partner has begun positive pressure ventilations. Which physical examination approach is most appropriate?

Show the answer and rationale

Correct answer · A systematic full-body scan of every body region

This patient is unresponsive, so the secondary assessment is a systematic full-body scan. A focused exam is for a responsive medical patient or a minor mechanism of injury. A focused exam depends on the patient telling you what hurts. An unresponsive patient cannot report pain. The patient also cannot confirm what happened in the pool. A patient who was under water for several minutes is usually unresponsive, like this one. Check every body region. You are looking for hidden life threats and injuries, even though nobody suspects trauma.

Why the others are wrong

A focused examination of the chest and lungs: The level of response decides the type of exam, not the body system you suspect, and this patient is unresponsive. A focused exam of the chest needs a responsive patient who can tell you what is wrong.

A focused examination guided by the bystanders' account: Nobody can confirm the bystanders' account of no dive and no fall, because this patient cannot answer questions. Taking a bystander's story as proof that nothing else is hurt is how hidden injuries get missed. That is why you check the whole body.

A neurologic examination with repeated pupil checks: A neurologic exam with pupil checks does not search the chest, abdomen, arms, and legs for injuries, and those are where the hidden life threats would be. An unresponsive patient gets the full-body scan, even when the problem seems to be in the brain.

Question 5 of 10

An EMT is caring for a 24-year-old patient who caught a foot on a stair tread and fell one step. The patient is alert and oriented, the airway is patent, and breathing is unlabored. The vital signs are BP 124/78 mmHg, P 88/min, R 16/min, and SpO₂ 99% on room air. The left lower leg is painful, swollen, and angulated, with a strong pedal pulse and normal sensation in the foot. No other injury is found. Which action is most appropriate before moving the patient to the ambulance?

Show the answer and rationale

Correct answer · Splint the injured leg to reduce pain during movement

Splint the leg before you move this patient. The airway is open, the breathing is unlabored, and the vital signs are normal. The only injury is the left lower leg, and the foot still has a strong pedal pulse and normal sensation. Nothing here is a life threat, so you do not need to rush off the scene. How fast you leave depends on the primary assessment, not on how bad the injury looks. With no life threat, easing the pain matters more than saving a minute. A leg that is painful, swollen, and angulated gets splinted before the patient is moved. Splinting first cuts down on pain, more soft tissue injury, and more bleeding during the lift and carry.

Why the others are wrong

Complete a systematic full-body scan of every region: A full-body scan is for a patient with a significant mechanism of injury. This patient fell one step. A fall of one step is not a significant mechanism. The primary assessment is normal and there is one obvious injury. This patient needs a focused exam of the injured leg.

Move the patient to the stretcher and splint en route: Splinting en route is for a critically injured patient, where every minute on scene counts. This patient has a normal primary assessment and one isolated leg injury. Splinting first keeps the move from causing more pain and more injury.

Begin high-concentration oxygen before moving the patient: Oxygen is for a patient who is hypoxic or not breathing well enough. This patient's breathing is unlabored and the SpO₂ is 99% on room air.

Question 6 of 10

An EMT is on scene with a 37-year-old patient who was struck by a car. The patient responds only to painful stimulus, has snoring respirations that clear when a partner maintains a jaw-thrust maneuver, and has cool, pale skin with a weak radial pulse. Bleeding from a scalp laceration is controlled. The right forearm and both lower legs are deformed and swollen. The scene is secured and a trauma center is 14 minutes away. What should the EMT do?

Show the answer and rationale

Correct answer · Package the patient now and splint the extremities en route

This patient is critically injured. Being struck by a car is a dangerous mechanism of injury. Responding only to pain is a decreased level of consciousness. Snoring respirations, cool pale skin, and a weak radial pulse are threats to the airway and circulation. Any one of these marks a critical trauma patient, and this patient has all three. A critical trauma patient gets only the scene time needed to fix life threats and package for transport. This window is called the platinum 10 minutes, inside the golden hour. The airway is already managed and the scalp bleeding is controlled. Nothing left to do on scene will save this patient's life. Package the patient now and go to the trauma center 14 minutes away. The extremities are held in place on the backboard, and you splint each one in the ambulance as time allows.

Why the others are wrong

Splint each deformed extremity, then package for transport: Three splints on scene use up the time this patient needs to reach the trauma center 14 minutes away. The patient responds only to pain and has cool, pale skin and a weak radial pulse, which makes this a critical trauma patient. Splint the extremities in the ambulance as time allows.

Obtain a full set of vital signs, then splint each extremity: A full set of vital signs is part of the secondary assessment. The secondary assessment is done once life threats are under control, and for this patient that happens en route. Stopping for vitals and then splinting only adds scene time.

Complete a systematic head-to-toe examination, then package: A critical patient gets the head-to-toe exam in the ambulance. Doing the exam on scene delays transport for a patient who needs a jaw thrust to keep the airway open and has poor perfusion.

Question 7 of 10

An EMT is called for an 84-year-old patient who tripped on a rug and has an isolated deformed, swollen ankle with a strong pedal pulse. The patient is alert and oriented, reports no head strike, and has no chest discomfort at rest. The vital signs are BP 142/84 mmHg, P 86/min, R 16/min, and SpO₂ 97% on room air. A family member reports the patient was hospitalized last month for unstable angina and has had chest discomfort with minimal exertion since. The ankle has been splinted. Which transport decision is most appropriate?

Show the answer and rationale

Correct answer · Prompt transport, completing the remaining assessment en route

Transport this patient promptly. The ankle injury on its own is minor, but the heart history makes this patient potentially unstable. The patient was hospitalized last month for unstable angina and has had chest discomfort with minimal exertion since. The pain and stress of the ankle injury can make the angina worse. A past medical problem counts toward how stable a patient is, even when the patient has no symptoms right now. Get moving and finish the rest of the assessment on the way to the emergency department. Age adds to the risk too. Older patients are more likely to be seriously hurt or die from trauma, and their findings are harder to spot.

Why the others are wrong

Transport without urgency, since the injury is isolated: This patient was hospitalized last month for unstable angina and has had chest discomfort with minimal exertion since. The pain and stress of even a minor injury can bring on a cardiac event, so the isolated ankle does not make this a routine transport.

Delay transport until a head-to-toe examination is complete: A patient who could become unstable gets the rest of the assessment en route. Finishing a complete exam on scene costs time this patient should spend moving toward the hospital.

Delay transport until an advanced life support unit responds: No chest discomfort at rest and stable vital signs leave ALS nothing to treat right now. Waiting for ALS only uses up the time prompt transport is meant to save.

Question 8 of 10

An EMT is on scene with a 29-year-old patient who was the unrestrained driver in a head-on collision with intrusion into the passenger compartment. The airway has been opened, positive pressure ventilations have been started for shallow breathing, and bleeding from a forearm wound has been controlled. The patient responds to voice only. The scene is secured, the crew is ready to move the patient, and a trauma center is 16 minutes away. Which assessment step is most appropriate now?

Show the answer and rationale

Correct answer · A rapid exam of the entire body before moving the patient

This patient has a significant mechanism of injury. The patient was the unrestrained driver in a head-on collision with intrusion into the passenger compartment, and responds to voice only. The life threats you found are handled. The airway is open, positive pressure ventilations have started, and the forearm bleeding is controlled. The next step is a rapid exam of the entire body. A rapid exam takes no more than 90 seconds. The rapid exam looks for other injuries you need to manage before you move the patient. A rapid exam is not the same as a focused exam. The full secondary assessment takes much longer. Do the secondary assessment in the ambulance on the way to the trauma center, once the life threats are under control. If managing the life threats takes the whole ride, the secondary assessment can be cut short.

Why the others are wrong

A focused examination of the forearm wound and the chest: The forearm wound is the injury you can see, and the chest is where the breathing problem is. A focused exam is for a patient with a nonsignificant mechanism, or a responsive medical patient. This patient is neither. The injuries most likely to kill this patient are the ones you have not found yet.

A detailed secondary assessment of every body region: A detailed secondary assessment looks at every body region, and it takes much longer than a rapid exam. For a critically injured patient, the detailed assessment is done in the ambulance. The rapid exam is short enough to finish before the move.

A repeat primary assessment every five minutes until transport: Repeating the primary assessment every five minutes is the right interval for an unstable patient. Reassessing on scene does not look for the other injuries a rapid exam would find. Reassessment happens en route, and it is not a reason to stay on scene.

Question 9 of 10

A 58-year-old patient has had chest pressure for 40 minutes. The patient is pale and sweaty, with clear lung sounds on both sides and distended neck veins. Vital signs are BP 132/84 mmHg, P 56/min, R 20/min, SpO₂ 95%. The EMT helped the patient take the first prescribed sublingual nitroglycerin tablet. Five minutes later the patient is lightheaded, BP is 82/50 mmHg, P is 52/min, and the chest pressure is unchanged. The patient asks for the second tablet. What should the EMT do next?

Show the answer and rationale

Correct answer · Stop the nitroglycerin and transport rapidly, rechecking the pressure en route

The question tells you this patient has chest pressure, clear lung sounds, and distended neck veins, and that combination points to a right ventricular or inferior myocardial infarction, a right-sided problem that depends on preload, not fluid backed up into the lungs. Nitroglycerin lowers preload, and in that setting it can drop the blood pressure sharply even when the first numbers look fine. After the first tablet the pressure fell from 132/84 to 82/50 mmHg and the patient became lightheaded, well below the 100 mmHg systolic cutoff for nitroglycerin. The slow pulse fits the same picture, since an inferior infarction sometimes brings bradycardia. The blood pressure is checked before every dose, and unchanged pain does not make another dose safe. That's why the EMT stops the nitroglycerin and transports rapidly while rechecking the pressure.

Why the others are wrong

Sit the patient upright and start continuous positive airway pressure (CPAP): Continuous positive airway pressure treats fluid in the lungs, and this patient has clear lungs. The device also lowers the blood returning to the heart, and a systolic pressure below 90 mmHg is a reason not to use it, which rules it out at 82/50 mmHg.

Wait for the pressure to recover on scene, then help with the second tablet: Clear lungs with distended neck veins mean a right-sided problem that depends on preload, so a second tablet carries the same risk even after the pressure comes back. This patient needs to be moving to the hospital, not waiting on scene.

Help with the second tablet to treat the unchanged chest pain: At 82/50 mmHg the pressure is below the cutoff, and the pressure is checked before every tablet. Distended neck veins with clear lungs say the heart depends on preload, so a second tablet could drop the pressure further. Unchanged pain does not make another dose safe.

Question 10 of 10

A 45-year-old patient has acute onset chest pain and difficulty breathing. The primary assessment finds an alert and anxious patient with a patent airway, rapid and shallow breathing, and pale, diaphoretic skin. The vital signs are BP 96/62 mmHg, P 118/min, R 24/min, and SpO₂ 90% on room air. Which transport decision is most appropriate?

Show the answer and rationale

Correct answer · Emergent transport with high-concentration oxygen and reassessment en route

This patient is unstable. The chest pain comes with signs of shock and low oxygen. The SpO2 is 90% on room air, the BP is 96/62, the pulse is 118, and the skin is pale and diaphoretic. Oxygen delivery to the tissues is already failing. The fast pulse and the pale skin show the body trying to make up for it. The heart speeds up, and the vessels in the skin narrow to push blood to the core. Keep scene time short. Put high-concentration oxygen on right away. Transport emergent and keep reassessing on the way to the hospital.

Why the others are wrong

Non-emergent transport; have the patient walk to the ambulance and position the patient comfortably: Walking to the ambulance is fine for a stable patient. This patient has a BP of 96/62 and an SpO2 of 90%. Walking raises the heart's oxygen demand in a patient who is already low on oxygen. This patient goes on the stretcher.

Non-emergent transport by stretcher, reassessing the vital signs every 15 minutes: The stretcher is right, and the vital signs do need rechecking. Rechecks every 15 minutes and non-emergent transport are for a stable patient. A pulse of 118, a BP of 96/62, and an SpO2 of 90% make this patient unstable. An unstable patient gets reassessed every 5 minutes on an emergent transport.

Delay transport on scene until a paramedic unit arrives to assume patient care: Waiting for a paramedic unit makes sense when your crew truly cannot manage the patient. You can give oxygen and move this patient now. Staying on scene only adds time for a patient who is already in shock.

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