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TP-C practice questions

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Question 1Tactical Paramedic specialty knowledge domain

During a prolonged tactical operation, a Tactical Paramedic is establishing a casualty collection point. Which principle best guides the placement of this point relative to the assault element?

  1. Locate it on the most direct route to the nearest trauma center
  2. Set it directly adjacent to the command post for easy communication
  3. Position it within the objective building to shorten evacuation distance
  4. Place it in a covered and concealed location behind the assault element's line of advance Correct answer.

Explanation

The casualty collection point should be positioned in a covered and concealed location behind the forward line of troops, so casualties can be consolidated and treated without exposing the position or blocking the assault element's movement. Placing it forward or on an obvious route increases risk from hostile fire.

Question 2Tactical Paramedic specialty knowledge domain

Which characteristic distinguishes the Tactical Paramedic scope of practice from that of a conventional civilian paramedic?

  1. Expanded practice under a tactical medical director, including prolonged field care and operational duties Correct answer.
  2. Permission to prescribe and dispense controlled substances independently
  3. Licensure as a physician assistant in austere settings
  4. Authority to perform surgical cricothyrotomy without medical direction

Explanation

Tactical Paramedics operate under a tactical medical director with an expanded protocol set that emphasizes prolonged field care, operational integration, and delayed evacuation. They do not gain independent prescriptive authority or a different license by virtue of the tactical role.

Question 3Tactical Paramedic specialty knowledge domain

A Tactical Paramedic is treating a casualty with a gunshot wound to the lateral thigh and severe hemorrhage uncontrolled by direct pressure. What is the most appropriate next intervention?

  1. Elevate the limb above heart level and continue direct pressure
  2. Pack the wound with hemostatic gauze and apply a pressure dressing only
  3. Apply a tourniquet 5 to 7 cm proximal to the wound, not over a joint Correct answer.
  4. Apply a tourniquet high and tight over the groin

Explanation

For extremity hemorrhage not controlled by pressure, a tourniquet is placed proximal to the wound, roughly 5 to 7 cm above it, avoiding placement directly over a joint. High-and-tight placement is reserved for situations where the wound location cannot be identified or bleeding is not controlled by a standard placement.

Question 4Tactical Paramedic specialty knowledge domain

In the tactical field care phase, which finding is the primary indication for initiating a needle decompression of the chest?

  1. Tracheal deviation with distended neck veins
  2. Localized chest wall tenderness with intact breath sounds
  3. Progressive respiratory distress with absent breath sounds and hypotension on the affected side Correct answer.
  4. Subcutaneous emphysema over the clavicle

Explanation

Needle decompression is indicated for suspected tension pneumothorax, signaled by worsening respiratory distress, absent or decreased breath sounds on the affected side, and hemodynamic compromise such as hypotension. Tracheal deviation is a late and unreliable sign.

Question 5Tactical Paramedic specialty knowledge domain

Which statement accurately describes the 'care under fire' phase of tactical casualty care?

  1. It prioritizes rapid control of life-threatening hemorrhage and moving the casualty to cover while returning fire as needed Correct answer.
  2. It is conducted only after the tactical situation has been declared secure
  3. It begins after the casualty has been moved to cover and full assessment is performed
  4. It focuses on definitive airway management and intravenous access

Explanation

Care under fire occurs while the threat is still active; the priorities are suppressing the threat, moving the casualty to cover, and controlling massive hemorrhage with a tourniquet. Definitive airway and vascular access are deferred to later phases when the scene is safer.

Question 6Tactical Paramedic specialty knowledge domain

A casualty in a tactical setting has an open pneumothorax. Which intervention is most appropriate before definitive management?

  1. Pack the wound with hemostatic gauze
  2. Perform immediate needle decompression of the unaffected side
  3. Apply an occlusive dressing sealed on all four sides
  4. Apply a vented chest seal or an occlusive dressing taped on three sides Correct answer.

Explanation

An open chest wound is managed with a vented chest seal or an occlusive dressing that allows air to escape, such as one taped on three sides, to prevent conversion to a tension pneumothorax. Fully occlusive seals can trap air and cause deterioration.

Question 7Tactical Paramedic specialty knowledge domain

Which of the following best defines the tactical evacuation (TACEVAC) phase?

  1. The initial 10 minutes of casualty assessment at the point of injury
  2. Rehabilitation and return-to-duty screening after treatment
  3. Movement of the casualty to a higher level of care using vehicles or aircraft with en route treatment Correct answer.
  4. Care rendered while the casualty is still under direct hostile fire

Explanation

TACEVAC covers moving the casualty to definitive care using ground or air assets while providing en route treatment. It follows tactical field care and is distinct from care under fire and from point-of-injury assessment.

Question 8Tactical Paramedic specialty knowledge domain

When preparing a casualty for transport, which action is most consistent with tactical movement principles?

  1. Delay movement until all wounds have been definitively dressed
  2. Secure the casualty and equipment to prevent movement, and use drags or carries that keep the rescuer low and behind cover Correct answer.
  3. Move the casualty in a fully upright walking position to speed evacuation
  4. Transport the casualty alone to avoid exposing additional team members

Explanation

Casualty movement should keep the rescuer and casualty low and behind cover, with the casualty and equipment secured. Tactical carries and drags protect the rescuer while moving the casualty out of the line of fire.

Question 9Tactical Paramedic specialty knowledge domain

A Tactical Paramedic is assessing a casualty with suspected pelvic fracture after a blast injury. Which finding most strongly supports this suspicion?

  1. Pelvic instability on gentle compression with hypotension Correct answer.
  2. Localized lumbar muscle spasm
  3. Isolated ankle fracture with intact distal pulses
  4. Bilateral femur deformity

Explanation

Pelvic instability on gentle compression combined with hypotension suggests a pelvic fracture with associated hemorrhage, which can be life-threatening. The pelvis should be stabilized with a binder and hemorrhage addressed.

Question 10Tactical Paramedic specialty knowledge domain

During tactical field care, a casualty with a traumatic amputation of the forearm has a tourniquet in place. Which additional measure is most appropriate?

  1. Replace the tourniquet with a figure-eight bandage
  2. Remove the tourniquet once bleeding appears controlled and apply a pressure dressing
  3. Leave the tourniquet tightened and document the time of application Correct answer.
  4. Loosen the tourniquet every 15 minutes to check for bleeding

Explanation

Once a tourniquet is applied for life-threatening extremity hemorrhage, it should be left in place and the application time documented; loosening can precipitate rebleeding and shock. Conversion to a pressure dressing is considered later under medical direction when definitive care is near.

Question 11Tactical Paramedic specialty knowledge domain

Which statement about the use of ketamine for analgesia in a tactical setting is most accurate?

  1. It reliably reverses hypotension in hemorrhagic shock
  2. It is contraindicated in any casualty with a suspected head injury
  3. It provides dissociative analgesia with preservation of airway reflexes at subdissociative doses Correct answer.
  4. It should be given only by intramuscular route because IV access is never available

Explanation

At subdissociative doses, ketamine provides effective analgesia while generally preserving airway reflexes and respiratory drive, which suits austere tactical settings. It does not correct hemorrhagic hypotension and is not absolutely contraindicated in head injury when appropriately used.

Question 12Tactical Paramedic specialty knowledge domain

A casualty with severe hemorrhage is being resuscitated in an austere tactical setting where blood products are unavailable. Which approach best reflects current damage-control resuscitation principles?

  1. Withholding all fluids until the casualty reaches the hospital
  2. Rapid infusion of large volumes of crystalloid to restore normal blood pressure
  3. Permissive hypotension with limited crystalloid and early use of tranexamic acid when indicated Correct answer.
  4. Administration of hypertonic saline to expand intravascular volume

Explanation

Damage-control resuscitation emphasizes limiting crystalloid, accepting permissive hypotension until hemorrhage is controlled, and giving tranexamic acid early when indicated. Large-volume crystalloid worsens dilutional coagulopathy and hypothermia.

Question 13Tactical Paramedic specialty knowledge domain

A Tactical Paramedic must decide whether to treat a casualty at the point of injury or move them. Which consideration most strongly favors immediate movement to cover?

  1. Ongoing hostile fire makes the current position untenable Correct answer.
  2. The wound appears minor on initial inspection
  3. The casualty's vital signs are stable
  4. The casualty requests to remain in place

Explanation

When the current position is exposed to ongoing hostile fire, the priority is to move the casualty to cover before or while providing care. Treating in an exposed position endangers both the casualty and the provider.

Question 14Tactical Paramedic specialty knowledge domain

Which finding in a casualty with a suspected spinal injury should prompt spinal motion restriction during tactical evacuation?

  1. Complaint of mild ankle sprain
  2. Stable gait and full orientation
  3. Mechanism suggesting spinal trauma with neurologic deficit or altered mental status Correct answer.
  4. Isolated abrasion to the forearm

Explanation

Spinal motion restriction is indicated when the mechanism suggests spinal trauma and there is neurologic deficit, altered mental status, or distracting injury. Isolated minor injuries with a stable, oriented casualty generally do not require it.

Question 15Tactical Paramedic specialty knowledge domain

During a prolonged field care scenario, a casualty's hypothermia is a concern. Which measure is most appropriate?

  1. Keep the casualty exposed to airflow to prevent overheating
  2. Administer cold intravenous fluids to maintain vascular tone
  3. Apply wet cooling sheets to reduce metabolic demand
  4. Remove wet clothing and use passive or active warming with insulation Correct answer.

Explanation

Hypothermia worsens coagulopathy and should be prevented by removing wet clothing and using insulation and active warming. Cold fluids and exposure to airflow worsen heat loss.

Question 16Tactical Paramedic specialty knowledge domain

Which statement best describes the Tactical Paramedic's role in the tactical emergency medical support (TEMS) team during a high-risk warrant service?

  1. To serve as the primary entry element during the breach
  2. To document only post-incident injuries
  3. To negotiate with the subject during the operation
  4. To provide medical planning, casualty care, and medical intelligence support to the tactical commander Correct answer.

Explanation

The Tactical Paramedic supports the tactical commander through medical planning, casualty care, and medical intelligence, integrating medical considerations into the operation. The paramedic is not an assault element or negotiator.

Question 17Tactical Paramedic specialty knowledge domain

A casualty with a suspected tension pneumothorax is being treated in a tactical setting. After needle decompression, which finding best indicates the procedure was successful?

  1. Improved respiratory effort and hemodynamics Correct answer.
  2. Increased resistance when aspirating the needle
  3. Continued hypotension with worsening distress
  4. Development of subcutaneous emphysema at the site

Explanation

Successful decompression is indicated by improved respiratory effort, easier ventilation, and hemodynamic improvement. Continued deterioration suggests the decompression was ineffective or another cause is present.

Question 18Tactical Paramedic specialty knowledge domain

Which of the following is the most appropriate initial action when a Tactical Paramedic encounters a casualty with an impaled object in the abdomen?

  1. Cut the object flush with the skin and apply pressure
  2. Push the object deeper to control bleeding
  3. Remove the object to assess the wound
  4. Stabilize the object in place and dress around it Correct answer.

Explanation

An impaled object should be stabilized in place and dressed around to prevent further injury and bleeding; removal can worsen hemorrhage. The object is left for definitive surgical management.

Question 19Tactical Paramedic specialty knowledge domain

A Tactical Paramedic is triaging multiple casualties after a blast. Which casualty should be prioritized for immediate treatment and evacuation?

  1. A casualty who is ambulatory with a sprained wrist
  2. A casualty with minor lacerations and normal vital signs
  3. A casualty with an arterial hemorrhage controlled by tourniquet and signs of shock Correct answer.
  4. A casualty with a closed femur fracture and stable vital signs

Explanation

Casualties with controlled major hemorrhage and signs of shock require urgent treatment and evacuation to prevent deterioration. Stable fractures and minor injuries can wait, and ambulatory patients are lower priority.

Question 20Tactical Paramedic specialty knowledge domain

Which statement accurately describes the use of the MARCH algorithm in tactical casualty care?

  1. It replaces the need for tactical movement to cover
  2. It sequences care as massive hemorrhage, airway, respiration, circulation, and head injury/hypothermia Correct answer.
  3. It prioritizes airway before hemorrhage control in all casualties
  4. It applies only to casualties with blast injuries

Explanation

MARCH sequences life-threatening priorities as massive hemorrhage control, airway, respiration, circulation, and head injury with hypothermia prevention. It is applied across mechanisms of injury, not limited to blast trauma.

Question 21Tactical Paramedic specialty knowledge domain

A casualty is receiving prolonged field care for several hours before evacuation. Which complication is most important to monitor for and prevent?

  1. Coagulopathy worsened by hypothermia and acidosis Correct answer.
  2. Hypernatremia from fluid restriction
  3. Hyperthermia from excessive insulation
  4. Rhabdomyolysis from prolonged immobilization on a hard surface

Explanation

In prolonged field care, the lethal triad of hypothermia, acidosis, and coagulopathy is a major threat and must be actively prevented. Monitoring and correcting temperature and perfusion are central to prolonged casualty management.

Question 22Tactical Paramedic specialty knowledge domain

During a tactical operation, a casualty develops signs of tension pneumothorax after a blast injury. Which sequence best reflects current tactical casualty care priorities?

  1. Delay all interventions until the casualty is evacuated
  2. Administer analgesia before any lifesaving intervention
  3. Perform needle decompression before addressing any extremity hemorrhage
  4. Control massive hemorrhage first, then address airway and breathing including decompression Correct answer.

Explanation

Under the MARCH sequence, massive hemorrhage control precedes airway and breathing interventions. Once hemorrhage is controlled, thoracic decompression is performed for tension pneumothorax.

Question 23Tactical Paramedic specialty knowledge domain

A Tactical Paramedic is planning medical support for a prolonged rural operation with delayed evacuation. Which planning element is most critical to include?

  1. A prolonged field care plan with supplies for extended casualty management Correct answer.
  2. Deferral of medical planning to the tactical commander alone
  3. Reliance on a single evacuation route without backup
  4. Assumption that evacuation will occur within 30 minutes

Explanation

When evacuation may be delayed, planning must include prolonged field care capability with adequate supplies and a contingency plan. Assuming rapid evacuation or a single route leaves the team unprepared.

Question 24Tactical Paramedic specialty knowledge domain

A casualty with a suspected junctional hemorrhage at the groin is not controlled by direct pressure. Which intervention is most appropriate?

  1. Elevate the leg and apply a cold compress
  2. Apply a cervical collar and monitor
  3. Apply a tourniquet to the thigh distal to the wound
  4. Apply a junctional tourniquet or wound packing with hemostatic gauze and pressure Correct answer.

Explanation

Junctional hemorrhage at the groin cannot be controlled with a standard extremity tourniquet and requires a junctional tourniquet or aggressive wound packing with hemostatic gauze and pressure. Standard tourniquets applied distal to the wound are ineffective.

Question 25Tactical Paramedic specialty knowledge domain

Which consideration most accurately reflects the concept of tactical patience in casualty management?

  1. Treating casualties immediately regardless of the tactical situation
  2. Balancing the urgency of medical care against the risk of exposing the team to hostile fire Correct answer.
  3. Delaying all medical care until the operation is complete
  4. Evacuating casualties before securing the objective

Explanation

Tactical patience involves weighing the medical urgency of treating a casualty against the tactical risk of exposure, allowing the team to act when it is safest and most effective. It does not mean withholding all care or ignoring the tactical situation.

Question 26Tactical Paramedic specialty knowledge domain

Under the TECC guidelines, which phase of casualty care immediately follows care under fire?

  1. Tactical field care Correct answer.
  2. Tactical evacuation
  3. Casualty collection point operations
  4. Prolonged field care

Explanation

Care under fire is followed by tactical field care, which is rendered once the Tactical Paramedic and casualty are in a relatively safe position and the threat has been suppressed. Tactical evacuation and prolonged field care come later in the continuum, and casualty collection point operations are a movement/logistics activity rather than a care phase.

Question 27Tactical Paramedic specialty knowledge domain

Which characteristic best describes a commercial junctional tourniquet compared with a standard extremity tourniquet?

  1. It is designed to compress vessels at sites such as the inguinal or axillary region where a circumferential band cannot be applied Correct answer.
  2. It replaces the need for wound packing in all junctional injuries
  3. It is applied only after a standard tourniquet has failed to control distal bleeding
  4. It is intended solely for pediatric casualties

Explanation

Junctional tourniquets are engineered to occlude flow at anatomic junctions like the groin or axilla, where a conventional circumferential tourniquet cannot achieve adequate compression. They are used when direct pressure and packing fail at those sites, not as a universal replacement for packing.

Question 28Tactical Paramedic specialty knowledge domain

A Tactical Paramedic is caring for a casualty with hemorrhagic shock who is alert and can follow commands. Which finding is most consistent with compensated shock?

  1. Immediate loss of consciousness
  2. Narrowed pulse pressure with a relatively preserved systolic pressure Correct answer.
  3. Bradycardia with warm, dry skin
  4. Frank hypotension with a systolic pressure below 90 mmHg

Explanation

In compensated hemorrhagic shock, baroreceptor and catecholamine responses maintain systolic pressure while diastolic pressure rises, narrowing the pulse pressure. Frank hypotension and altered consciousness indicate decompensation, and bradycardia is not typical of early hemorrhagic shock.

Question 29Tactical Paramedic specialty knowledge domain

Which statement best describes the purpose of the casualty collection point (CCP) in a tactical operation?

  1. It is the initial point of injury where care under fire is rendered
  2. It is the forward surgical element that performs damage-control surgery
  3. It is the staging area for ammunition resupply
  4. It is a secure location where casualties are consolidated, reassessed, and prepared for evacuation Correct answer.

Explanation

A CCP is a designated, relatively secure site where casualties are gathered so the Tactical Paramedic can reassess, prioritize, and prepare them for evacuation. It is not the point of injury, a surgical facility, or a logistics node for ammunition.

Question 30Tactical Paramedic specialty knowledge domain

A casualty has sustained a blast injury and reports ringing in the ears, difficulty hearing, and minor external bleeding. Which injury pattern should the Tactical Paramedic suspect?

  1. Tertiary blast injury from being thrown
  2. Quaternary blast injury from burns
  3. Primary blast injury affecting gas-filled organs Correct answer.
  4. Secondary blast injury from fragmentation

Explanation

Primary blast injury results from the overpressure wave and preferentially affects gas-filled organs such as the ears and lungs, producing tympanic membrane rupture and hearing loss. Secondary injury involves fragments, tertiary involves displacement of the body, and quaternary covers burns and other effects.

Question 31Tactical Paramedic specialty knowledge domain

Which finding most strongly suggests that a casualty has developed compartment syndrome in a limb after a crush injury?

  1. Mild swelling that improves with elevation
  2. Numbness confined to the skin over the injury
  3. A palpable distal pulse with normal capillary refill
  4. Pain out of proportion to the visible injury that worsens with passive stretch Correct answer.

Explanation

Compartment syndrome classically produces pain out of proportion to findings and pain on passive stretch of the involved muscles, which are early and reliable signs. Pulses often remain palpable because arterial pressure exceeds compartment pressure, so a present pulse does not exclude the diagnosis.

Question 32Tactical Paramedic specialty knowledge domain

A Tactical Paramedic is preparing to perform a surgical cricothyrotomy on a casualty with massive facial trauma and an obstructed airway. Which landmark is correct for the incision?

  1. The first tracheal ring below the cricoid cartilage
  2. The thyroid cartilage just above the laryngeal prominence
  3. The cricothyroid membrane between the thyroid and cricoid cartilages Correct answer.
  4. The hyoid bone at the base of the tongue

Explanation

Surgical cricothyrotomy is performed through the cricothyroid membrane, which lies between the thyroid cartilage above and the cricoid cartilage below. This avascular membrane is superficial and accessible in an emergency airway.

Question 33Tactical Paramedic specialty knowledge domain

Which action best reflects the principle of tactical patience when a casualty has life-threatening bleeding that is already controlled?

  1. Applying additional tourniquets to all extremities as a precaution
  2. Remaining in a covered position and delaying movement until the threat is neutralized Correct answer.
  3. Immediately moving the casualty to an evacuation vehicle regardless of ongoing fire
  4. Abandoning the casualty to engage the threat

Explanation

Tactical patience means accepting a delay in movement or evacuation when moving now would expose the casualty and rescuers to greater danger than waiting. Once life-threatening bleeding is controlled, staying in cover until the threat is reduced is appropriate.

Question 34Tactical Paramedic specialty knowledge domain

A casualty with a suspected anterior shoulder dislocation is in severe pain during a tactical operation. Which field intervention is most appropriate?

  1. Routine administration of a paralytic agent
  2. Immediate surgical referral without any field intervention
  3. Application of a traction splint to the arm
  4. Analgesia and gentle reduction attempts when the tactical situation permits Correct answer.

Explanation

Field management of a suspected shoulder dislocation includes analgesia and, when the tactical situation allows, gentle reduction to relieve pain and restore function. Surgical referral and paralytics are inappropriate in this setting, and traction splints are for femur fractures.

Question 35Tactical Paramedic specialty knowledge domain

Which statement about hypothermia prevention during tactical field care is most accurate?

  1. Warming should be delayed until the casualty reaches definitive care
  2. Even mild hypothermia can worsen coagulopathy and should be prevented with insulation and passive warming Correct answer.
  3. Only casualties with a core temperature below 30 degrees Celsius require warming
  4. Hypothermia is beneficial because it reduces metabolic demand and should be encouraged

Explanation

Hypothermia contributes to the lethal triad by impairing coagulation and should be prevented early with insulation, removal of wet clothing, and passive warming. Waiting until definitive care allows further heat loss and worsening coagulopathy.

Question 36Tactical Paramedic specialty knowledge domain

A Tactical Paramedic is caring for a casualty with a suspected traumatic brain injury and signs of elevated intracranial pressure. Which action is most appropriate in the field setting?

  1. Maintaining adequate oxygenation and systolic blood pressure while elevating the head of the stretcher if tolerated Correct answer.
  2. Hyperventilating the casualty aggressively for a prolonged period
  3. Administering a large hypotonic fluid bolus to lower intracranial pressure
  4. Placing the casualty in a steep Trendelenburg position

Explanation

In suspected traumatic brain injury, preventing secondary injury by maintaining oxygenation and adequate perfusion pressure is central. Elevating the head modestly, when tolerated, aids venous drainage, whereas hypotonic fluids, prolonged aggressive hyperventilation, and Trendelenburg positioning can worsen the injury.

Question 37Tactical Paramedic specialty knowledge domain

Which statement best describes the role of the Tactical Paramedic in the tactical emergency medical support team during the planning phase of an operation?

  1. Handling logistics for ammunition and rations
  2. Directing the tactical commander's decisions on when to assault
  3. Contributing medical intelligence such as casualty estimation and evacuation planning to the mission plan Correct answer.
  4. Assuming command of the tactical element during the operation

Explanation

During planning, the Tactical Paramedic provides medical input such as casualty estimates, evacuation routes, and medical threat assessment to inform the mission plan. The paramedic advises the commander but does not direct tactical decisions or take command.

Question 38Tactical Paramedic specialty knowledge domain

A casualty in a tactical setting has an open chest wound with progressive respiratory distress. Which intervention is most appropriate after applying a vented chest seal?

  1. Monitor for signs of tension pneumothorax and perform needle decompression if deterioration occurs Correct answer.
  2. Immediately perform a thoracotomy
  3. Apply an occlusive dressing without any venting and leave it unmonitored
  4. Administer positive pressure ventilation at high volumes regardless of the seal

Explanation

A vented chest seal is applied to an open chest wound, and the casualty is monitored for tension pneumothorax, which may develop if the seal fails to vent. If deterioration occurs, needle decompression is performed. Thoracotomy is not a field procedure, and high-volume ventilation without monitoring can worsen air trapping.

Question 39Tactical Paramedic specialty knowledge domain

Which finding most reliably indicates adequate tourniquet application for a limb hemorrhage?

  1. Presence of a strong distal pulse
  2. Cessation of bleeding and absence of a distal pulse Correct answer.
  3. Continued slow oozing from the wound
  4. Complaint of mild pressure at the tourniquet site

Explanation

An effective tourniquet stops the bleeding and eliminates the distal pulse, confirming arterial occlusion. A persistent distal pulse or continued oozing suggests inadequate tightening or an improperly placed device.

Question 40Tactical Paramedic specialty knowledge domain

A casualty with severe hemorrhage has received a tourniquet and is now stable. During evacuation planning, which factor most influences the decision to convert the tourniquet?

  1. The casualty's request to remove the device
  2. The elapsed time since application and the presence of a controllable wound Correct answer.
  3. The rank of the casualty
  4. The color of the tourniquet

Explanation

Tourniquet conversion is considered based on how long the tourniquet has been in place and whether the underlying wound can be controlled by other means such as packing or pressure. Casualty preference, device color, and rank do not drive the clinical decision.

Question 41Tactical Paramedic specialty knowledge domain

Which statement about the use of tranexamic acid in tactical casualty care is most accurate?

  1. It replaces the need for hemorrhage control measures
  2. It should be given only after 24 hours from the time of injury
  3. It is contraindicated in all casualties with head injury
  4. It is most beneficial when given early after severe hemorrhage and should be administered as soon as feasible Correct answer.

Explanation

Tranexamic acid reduces mortality when given early after severe hemorrhage, so it should be administered as soon as feasible once the casualty is identified. It does not replace mechanical hemorrhage control and is not restricted to a late window.

Question 42Tactical Paramedic specialty knowledge domain

A Tactical Paramedic is assessing a casualty with a suspected tension pneumothorax who has a penetrating chest wound. Which sequence best reflects appropriate management?

  1. Administer a fluid bolus and defer all chest interventions
  2. Apply a fully occlusive dressing and observe without decompression
  3. Perform needle decompression, then apply a vented chest seal and reassess Correct answer.
  4. Perform a cricothyrotomy first and defer chest intervention

Explanation

For a suspected tension pneumothorax, immediate needle decompression relieves the pressure, followed by sealing the wound with a vented seal and reassessment. A fully occlusive unvented dressing can worsen air trapping, and airway or fluid interventions do not address the tension physiology.

Question 43Tactical Paramedic specialty knowledge domain

Which statement best describes the purpose of the MARCH algorithm in tactical casualty care?

  1. It is used only after evacuation to definitive care
  2. It replaces the need for a primary survey
  3. It sequences tactical movement before medical care
  4. It prioritizes life-threatening problems in order: massive hemorrhage, airway, respiration, circulation, and head injury/hypothermia Correct answer.

Explanation

MARCH organizes treatment priorities as massive hemorrhage, airway, respiration, circulation, and head injury/hypothermia, reflecting the leading causes of preventable death in tactical casualties. It structures the primary survey rather than replacing it and is used in the field.

Question 44Tactical Paramedic specialty knowledge domain

A casualty has a suspected pelvic fracture with hemodynamic instability after a blast. Which intervention is most appropriate during tactical field care?

  1. Encourage the casualty to walk to the evacuation point
  2. Perform repeated log rolls to assess the pelvis
  3. Apply traction to the lower extremities
  4. Apply a pelvic binder at the level of the greater trochanters and minimize movement Correct answer.

Explanation

A pelvic binder placed at the level of the greater trochanters stabilizes the pelvis and reduces venous bleeding, and minimizing movement limits further disruption. Repeated log rolls, traction, and ambulation can worsen bleeding and are inappropriate.

Question 45Tactical Paramedic specialty knowledge domain

Which statement about analgesia dosing in a Tactical Paramedic's care of a casualty in hemorrhagic shock is most accurate?

  1. Opioid analgesia should be titrated cautiously because shock alters drug distribution and clearance Correct answer.
  2. Full standard doses should be given regardless of perfusion status
  3. Analgesia should be withheld entirely in all shock states
  4. Only oral opioids should be used in shock

Explanation

In hemorrhagic shock, altered perfusion and hepatic and renal clearance can increase drug effect and prolong duration, so opioid analgesia should be titrated carefully. Withholding analgesia entirely is unnecessary, and full standard doses risk oversedation and respiratory depression.

Question 46Tactical Paramedic specialty knowledge domain

Which action is most appropriate when a Tactical Paramedic must move a casualty who is in a danger area with ongoing threat?

  1. Perform a full secondary survey before moving
  2. Use the fastest available means, such as a drag or carry, to move the casualty to cover Correct answer.
  3. Apply splints to all extremities before moving
  4. Wait for a formal litter team regardless of the threat

Explanation

When the casualty is in a danger area with an ongoing threat, the priority is rapid removal to cover using the fastest available means, such as a drag or carry. A full secondary survey and comprehensive splinting are performed later in tactical field care.

Question 47Tactical Paramedic specialty knowledge domain

A casualty with a suspected cervical spine injury must be moved during a tactical evacuation. Which approach best reflects current tactical casualty care principles?

  1. Limit spinal motion as the situation permits while prioritizing rapid extraction from the threat Correct answer.
  2. Perform manual in-line stabilization for an extended period regardless of the threat
  3. Refuse to move the casualty until a collar is available
  4. Apply full spinal immobilization with a backboard before any movement

Explanation

In tactical settings, spinal motion restriction is applied to the extent feasible while the priority remains rapid extraction from an ongoing threat. Rigid backboarding and prolonged in-line stabilization under fire can increase danger and delay care.

Question 48Tactical Paramedic specialty knowledge domain

Which statement about the use of ketamine for procedural sedation in a tactical setting is most accurate?

  1. Ketamine has no analgesic properties
  2. Ketamine is contraindicated in all casualties with hypovolemia
  3. Ketamine causes profound respiratory depression requiring routine paralysis
  4. Ketamine preserves airway reflexes and respiratory drive better than many sedatives but can cause emergence reactions Correct answer.

Explanation

Ketamine is attractive in austere tactical settings because it tends to preserve airway reflexes and respiratory drive while providing analgesia and amnesia, though emergence reactions can occur. It does not routinely require paralysis and is not absolutely contraindicated in hypovolemia.

Question 49Tactical Paramedic specialty knowledge domain

Which finding should prompt a Tactical Paramedic to reassess the airway in a casualty with facial burns?

  1. Mild facial erythema without swelling
  2. A dry cough that resolves
  3. Stable oxygen saturation with clear speech
  4. Progressive hoarseness and stridor Correct answer.

Explanation

Progressive hoarseness, stridor, and voice change suggest evolving upper airway edema in inhalation injury and warrant early airway planning. Stable oxygenation with clear speech and mild erythema are less concerning and do not indicate imminent obstruction.

Question 50Tactical Paramedic specialty knowledge domain

A Tactical Paramedic is triaging casualties after a mass-casualty blast. Which casualty should be assigned the lowest priority under a tactical triage framework?

  1. A casualty with a tension pneumothorax and severe respiratory distress
  2. A casualty with a small superficial laceration who is ambulatory and talking Correct answer.
  3. A casualty with an obstructed airway
  4. A casualty with an uncontrolled arterial hemorrhage

Explanation

In tactical and mass-casualty triage, ambulatory casualties with minor injuries are the lowest priority, while those with life-threatening conditions such as uncontrolled hemorrhage, tension pneumothorax, or airway obstruction require immediate intervention.