24 Scene Size-up & Safety Practice Questions & Answers

1. 1. During an adult mass-casualty incident you begin START triage. The first patient is breathing 34 times per minute and has a radial pulse. Using START, how should you tag this patient?

   • A.BLACK / Deceased
   • B.GREEN / Ambulatory
   • C.RED / Immediate✓ Answer
   • D.YELLOW / Delayed

   In START, a respiratory rate greater than 30 per minute is an automatic Immediate (RED) tag because it signals inadequate oxygenation and ventilation; you stop and tag without checking perfusion or mental status.

   Source: START triage algorithm (Hoag/Newport Beach), Respirations >30/min = ImmediateReport a problem with this question

2. 2. A patient in an MCI is breathing 24 times per minute, but you cannot feel a radial pulse and capillary refill is 3 seconds. Under START, this patient is:

   • A.GREEN / Ambulatory
   • B.RED / Immediate✓ Answer
   • C.BLACK / Deceased
   • D.YELLOW / Delayed

   Respirations are under 30, so you assess perfusion next; an absent radial pulse (or capillary refill greater than 2 seconds) indicates poor perfusion and requires an Immediate (RED) tag.

   Source: START triage algorithm — Perfusion: no radial pulse / cap refill >2 sec = ImmediateReport a problem with this question

3. 3. During START triage, a patient is breathing 20 times per minute and has a radial pulse, but cannot follow the simple command to squeeze your hand. This patient should be tagged:

   • A.YELLOW / Delayed
   • B.GREEN / Ambulatory
   • C.BLACK / Deceased
   • D.RED / Immediate✓ Answer

   With adequate respirations and perfusion, the final START check is mental status; a patient who cannot follow simple commands is tagged Immediate (RED) because altered mentation may indicate hypoxia or serious head injury.

   Source: START triage algorithm — Mental status: cannot follow commands = ImmediateReport a problem with this question

4. 4. Using JumpSTART on a young child in an MCI, you find the child is not breathing but you can palpate a pulse. Your next action is to:

   • A.Open the airway and give 5 rescue breaths✓ Answer
   • B.Start chest compressions and ventilations
   • C.Tag RED and move on without giving breaths
   • D.Tag BLACK because the child is apneic

   JumpSTART recognizes that pediatric arrests are usually respiratory in origin, so an apneic child WITH a pulse gets 5 rescue breaths; if breathing resumes, tag RED, and if it does not, tag BLACK.

   Source: JumpSTART pediatric triage algorithm (Romig) — apneic + pulse: 5 rescue breathsReport a problem with this question

5. 5. While performing START primary triage in an MCI, which interventions are you permitted to perform on patients as you sort them?

   • A.Opening the airway and stopping major bleeding✓ Answer
   • B.Splinting fractures and bandaging open wounds
   • C.Full BLS treatment before moving to the next
   • D.A complete set of vital signs on each patient

   During primary triage the goal is rapid sorting, so interventions are limited to opening the airway (repositioning) and controlling major hemorrhage; definitive treatment waits until triage is complete—triage precedes treatment.

   Source: START triage — interventions limited to airway positioning and hemorrhage control; triage before treatmentReport a problem with this question

6. 6. You arrive first at a multi-vehicle crash with at least six injured people. Before providing patient care, your priority action is to:

   • A.Load and transport the closest patient at once
   • B.Establish command and call for more resources✓ Answer
   • C.Treat the most seriously injured patient first
   • D.Wait for a supervisor before doing anything

   The first-arriving unit must establish command, perform a scene size-up, and request resources early—not begin treating one patient—because committing to a single patient (freelancing) leaves the incident unmanaged and resources unrequested.

   Source: NIMS/ICS — first-arriving unit establishes command and size-up; request resources early in MCIReport a problem with this question

7. 7. You arrive at an overturned tanker leaking an unknown liquid and displaying a placard. As an EMT trained to the awareness level, you should:

   • A.Isolate the area, deny entry, and call for HazMat✓ Answer
   • B.Enter at once to rescue any trapped victims
   • C.Drive downhill and downwind for a closer look
   • D.Decontaminate patients inside the hot zone

   EMTs are trained to the awareness level: recognize the hazard, isolate the scene, deny entry, and summon specialized HazMat resources—they do not enter the contaminated zone or attempt rescue/decon without proper training and PPE.

   Source: OSHA HAZWOPER (29 CFR 1910.120) — First Responder Awareness level: recognize, isolate, notifyReport a problem with this question

8. 8. When staging near a hazardous-materials release, how should you position yourself and your ambulance?

   • A.Uphill and upwind of the leak, in the cold zone✓ Answer
   • B.Downhill and downwind for a faster approach
   • C.As close to the leak as possible to observe it
   • D.Within the warm decontamination corridor

   You approach and stage uphill and upwind to avoid drifting vapors and liquid runoff, keeping the command post, staging, and patient treatment in the cold (safe) zone.

   Source: ERG / HazMat control zones — approach uphill/upwind; cold zone for command and treatmentReport a problem with this question

9. 9. According to the standard sequence of scene size-up, what is the FIRST step you take upon arriving at any scene?

   • A.Take BSI precautions and put on PPE✓ Answer
   • B.Determine the total number of patients
   • C.Identify the mechanism of injury
   • D.Request more units and resources

   Scene size-up begins with taking standard/BSI precautions and donning PPE, because provider safety comes first; you then assess scene safety, the mechanism or nature of illness, the number of patients, and the need for additional resources.

   Source: Scene size-up sequence — standard/BSI precautions first, then scene safety, MOI/NOI, patients, resourcesReport a problem with this question

10. 10. You are dispatched to a residence for a reported 'fall from a ladder.' While en route, what is the most appropriate use of this dispatch information?

    • A.Disregard it entirely until you can see the patient yourself
    • B.Anticipate likely injuries and equipment, then confirm on scene✓ Answer
    • C.Form a final field diagnosis before arriving at the address
    • D.Downgrade the response because most falls are not serious calls

    The first Domain 1 job task is developing a plan of action prior to arrival using dispatch information: the reported mechanism lets you mentally rehearse likely injury patterns and stage the right equipment and PPE. Dispatch information is provisional, however, so it must be re-evaluated during the actual scene size-up — it is never a final diagnosis, never ignored, and never a reason to downgrade before seeing the scene.

    Source: NREMT EMT Examination Specifications (2023 practice analysis), Domain 1 job task: 'Develop a plan of action prior to arrival utilizing dispatch information'Report a problem with this question

11. 11. You arrive at a nighttime crash on a high-speed highway before law enforcement. Which apparatus placement best protects the crew working at the scene?

    • A.Park beyond the next exit and walk back so that the roadway stays fully clear
    • B.Position the ambulance between oncoming traffic and the wreck as a barrier✓ Answer
    • C.Park on the opposite shoulder so oncoming drivers can see your warning lights
    • D.Park directly beside the damaged vehicle to shorten the equipment carries

    Traffic is the most common routine danger at roadway incidents, and standard practice is to use the apparatus as a physical blocking barrier — positioned between approaching traffic and the work area — so an errant vehicle strikes the truck, not the responders. Parking beside the wreck, across the road, or far past the scene leaves the crew exposed in a live traffic lane.

    Source: NREMT EMT test plan Domain 1: protect responders from existing hazards; NHTSA National EMS Education Standards — highway scene safety, apparatus blocking positionReport a problem with this question

12. 12. You are dispatched for a 'possible overdose.' On arrival you hear screaming inside the house, and a man is throwing objects at the front door. What should you do?

    • A.Stage at a safe distance and wait until police officers secure the scene✓ Answer
    • B.Enter quickly, since an overdose patient may stop breathing at any moment
    • C.Walk to the door, loudly identify yourselves as EMS, and then go straight in
    • D.Have your partner distract the man while you slip inside to reach the patient

    Personal safety always comes before patient care: EMTs do not enter a scene with active violence, because an injured rescuer helps no one and creates a second patient. The correct action for any unsecured violent scene — including overdoses with agitated persons — is to stage at a safe distance and enter only after law enforcement has secured it. This is one of the most commonly missed Domain 1 decisions, where candidates wrongly choose to begin assessment.

    Source: NREMT EMT test plan Domain 1: protect self and other responders from potential hazards; EMS scene-safety doctrine — stage for law enforcement at violent/unsecured scenesReport a problem with this question

13. 13. A car has struck a utility pole and a power line now lies across the vehicle. The line is not sparking or moving. What should you assume and do?

    • A.Assume the line is energized, keep everyone back, and call the utility company✓ Answer
    • B.Move the line off the car with a dry wooden pole so you can reach the patient
    • C.Assume the line is dead because it is not sparking, and approach the car
    • D.Tell the occupants to step out quickly without touching the vehicle's metal

    Every downed line must be treated as energized until the utility company confirms otherwise — lines can be live without sparking, and automatic reclosers can re-energize a 'dead' line without warning. Only utility crews may move or de-energize wires; EMTs establish a wide safety zone and tell uninjured occupants to remain inside the vehicle, since exiting can bridge the current path to ground.

    Source: NREMT EMT test plan Domain 1: hazard protection; NHTSA National EMS Education Standards — electrical hazards: assume all downed lines are energized, notify the utilityReport a problem with this question

14. 14. At a shooting scene secured by police, you must expose a gunshot wound on the patient's chest. How should you handle the patient's shirt?

    • A.Cut straight through the bullet hole so the wound is exposed the fastest
    • B.Leave the shirt in place untouched until the detectives photograph it
    • C.Delay exposing the wound until law enforcement gives you clear permission
    • D.Cut around the bullet hole, avoiding it, and save the shirt for the police✓ Answer

    On a secured crime scene, patient care always takes priority over evidence preservation, but the EMT should preserve evidence whenever doing so does not delay care: never cut through bullet or knife holes in clothing, because the hole itself is forensic evidence, and hand removed clothing to law enforcement. Waiting for photographs or for permission delays care of a potentially life-threatening wound.

    Source: NREMT EMT test plan Domain 1: protect the scene; NHTSA National EMS Education Standards — crime scene awareness: do not cut through holes in clothing, patient care precedes evidenceReport a problem with this question

15. 15. A man is struggling in a pond about 30 feet from shore. You are alone, have no water-rescue training, and a rope and a throwable flotation ring are at hand. What should you do first?

    • A.Wade in up to your chest so that your throw will be shorter and more accurate
    • B.Swim out to him immediately, since he could go under before any help arrives
    • C.Remain on shore and take no action until the water-rescue team is on scene
    • D.Throw him the flotation ring from shore while calling for trained rescuers✓ Answer

    Water emergencies follow the sequence reach–throw–row–go: rescuers attempt the safest shore-based options first and never enter the water without training and flotation. At 30 feet, reaching is impossible, so throwing the flotation device from shore is the correct first action — it may keep the victim afloat without creating a second drowning victim, and it does not preclude summoning the rescue team at the same time.

    Source: NHTSA National EMS Education Standards / EMT curriculum water-rescue rule: 'reach, throw, row, go' — shore-based rescue before entering the water; NREMT Domain 1 hazard protectionReport a problem with this question

16. 16. Your patient has fever, night sweats, and a productive cough, and his family states he is being tested for tuberculosis. Which respiratory protection is appropriate?

    • A.An N95 respirator on the patient, with no mask needed for the EMT crew
    • B.No masks for anyone, because gloves alone satisfy standard precautions
    • C.A surgical mask on yourself, since TB droplets are heavy and settle rapidly
    • D.An N95 respirator on yourself and a surgical mask placed on the patient✓ Answer

    Tuberculosis spreads by small airborne particles that remain suspended in the air, so a fitted N95 (or better) respirator is required to filter the EMT's inspired air — a surgical mask does not seal and cannot protect the wearer from airborne disease. Placing a surgical mask (or non-rebreather) on the patient reduces the droplets he releases at the source. This is the classic escalate-by-hazard PPE choice in Domain 1.

    Source: NREMT EMT test plan Domain 1: don appropriate PPE based on known hazards; CDC/OSHA airborne-precaution standard — N95 respirator for suspected TB, mask the patientReport a problem with this question

17. 17. You respond to a calm older adult with ankle pain after a ground-level fall. No bleeding or body fluids are visible. What is the appropriate minimum PPE for patient contact?

    • A.Gloves plus a fluid-resistant gown
    • B.No barrier PPE for this patient
    • C.Disposable exam gloves only✓ Answer
    • D.Gloves plus an N95 respirator mask

    Standard precautions apply to every patient regardless of appearance, so gloves are the minimum for any patient contact — even when no fluids are visible, because exposure risk cannot be judged by looks. The exam rewards selecting the minimum appropriate level for the described hazard: a gown or N95 adds nothing for a dry, low-risk musculoskeletal complaint, while skipping PPE entirely violates standard precautions.

    Source: NREMT EMT test plan Domain 1: PPE selection; CDC standard precautions — gloves for all patient contact, escalate PPE only per exposure riskReport a problem with this question

18. 18. You are sizing up a moderate-speed two-car crash. Which single finding, by itself, indicates a significant mechanism of injury?

    • A.Deployment of the front airbags in one vehicle
    • B.Bumper damage severe enough to require towing
    • C.The death of another occupant in the same vehicle✓ Answer
    • D.A cracked windshield caused by loose cargo inside

    Death of another occupant in the same passenger compartment is a classic significant MOI: it proves the crash delivered lethal forces to that compartment, so surviving occupants must be assumed to have absorbed similar energy and are treated as high-risk trauma patients. Airbag deployment, cargo-cracked glass, and bumper damage describe vehicle damage, not forces transmitted to the occupants, and none alone meets the significant-MOI criteria.

    Source: NHTSA National EMS Education Standards / CDC field triage significant-MOI criteria: death of an occupant in the same passenger compartment; NREMT Domain 1 MOI determinationReport a problem with this question

19. 19. At a single-car crash you find one injured adult driver. In the back seat you notice an empty, still-buckled child safety seat and a diaper bag. What should this prompt you to do?

    • A.Assume the child stayed home, since the safety seat is completely empty
    • B.Rely on the dispatch report, which stated that only one person was hurt
    • C.Search the vehicle and the surrounding area for a possible child patient✓ Answer
    • D.Finish the driver's full assessment before asking anyone about the seat

    Determining the number and location of patients is a core Domain 1 task, and the EMT must actively search for additional patients rather than trust assumptions or dispatch counts, which are frequently wrong. Clues such as car seats, toys, or diaper bags mean a small child may have been ejected, thrown under a seat, or may have wandered from the scene — so the search happens immediately, before committing to single-patient care.

    Source: NREMT EMT test plan Domain 1 job task: 'Investigate the scene to determine the number of potential patients'; EMT curriculum — search for additional patients (car seats, toys, wandering victims)Report a problem with this question

20. 20. On a winter evening you respond to a home where a mother and her two children all report headache, nausea, and dizziness that began tonight. What should you do first?

    • A.Move everyone out of the house and suspect carbon monoxide exposure✓ Answer
    • B.Administer high-flow oxygen to each patient right where you found them
    • C.Assess each person inside the home, starting with the sickest child
    • D.Treat it as food poisoning and ask exactly what the family ate at dinner

    Multiple patients in the same enclosed space with the same nonspecific symptoms — headache, nausea, dizziness — in cold weather is the classic scene clue for carbon monoxide poisoning, and the house itself is the hazard. Scene safety requires evacuating everyone, including the crew, before assessment or treatment; remaining inside to assess or give oxygen keeps every person, and you, in the toxic atmosphere.

    Source: NREMT EMT test plan Domain 1: nature of illness from scene clues and hazard protection; EMT curriculum CO-exposure rule — multiple patients, same environment, same symptoms: evacuate firstReport a problem with this question

21. 21. Which situation is best classified as a mass-casualty incident (MCI)?

    • A.Any incident that requires three or more ambulances to be dispatched
    • B.Any incident with ten or more injured patients present at one time
    • C.Any incident whose patient needs exceed the resources available on hand✓ Answer
    • D.Any incident formally declared a disaster by state or federal officials

    An MCI is defined by the ratio of patients to available resources, not by any absolute number of victims or any official declaration: whenever demand outstrips what the on-scene units can manage, it is an MCI. That is why a three-patient rural crash covered by a single ambulance qualifies, and recognizing this triggers ICS, triage, and early requests for more resources.

    Source: NHTSA National EMS Education Standards / EMT curriculum MCI definition — patients versus resources ratio; NREMT Domain 1 job task: triage patients to ensure optimal careReport a problem with this question

22. 22. You begin START triage at an industrial explosion with roughly 15 victims. What is your first triage action?

    • A.Check breathing on the nearest motionless victim that you can reach
    • B.Direct everyone who can walk to move to a designated collection area✓ Answer
    • C.Assess the victims one by one in the exact order you encounter them
    • D.Go first to the loudest, most distressed victims, as they are sickest

    The first step of START is a global sorting command: instruct all ambulatory victims to walk to a designated area, which tags them Green/Minor as a group and clears the field. This works because walking demonstrates an open airway, adequate perfusion, and the ability to follow commands, letting the triage officer concentrate the RPM assessment on the non-ambulatory victims who may need Red or Black tags. Loudness signals an open airway, not severity.

    Source: START triage algorithm (Simple Triage And Rapid Treatment), step 1: ambulatory patients directed to a collection point and tagged Green; NREMT Domain 1 triage job taskReport a problem with this question

23. 23. You find a conscious driver pinned under the dashboard of a badly deformed car. Your ambulance carries no extrication equipment. When should you request the rescue/extrication unit?

    • A.After ALS providers arrive and confirm that the patient is truly critical
    • B.After you and your partner try opening the doors and freeing him yourselves
    • C.Immediately, as soon as you recognize that the patient is entrapped✓ Answer
    • D.After you complete a primary assessment through the open car window

    Additional resources are requested during the scene size-up, the moment the need is recognized — before becoming committed to patient care — because rescue units have long response times and every minute of delay extends the entrapment. Waiting until after assessment, after failed self-rescue attempts, or after ALS confirmation is the classic exam trap of delaying a resource request that should have been made first.

    Source: NREMT EMT test plan Domain 1 job task: 'Request appropriate resources based upon hazards and/or patients' conditions' — resources requested early in size-up, before committing to careReport a problem with this question

24. 24. A worker has collapsed at the bottom of an underground utility vault. His coworker begs you to climb down and help him right away. What is the correct action?

    • A.Lower the coworker down on a rope, since he knows the vault's inside layout
    • B.Put on your N95 respirator, then descend and begin caring for the patient
    • C.Climb down quickly while holding your breath in order to reach the worker
    • D.Stay out of the vault and request a specialized confined-space rescue team✓ Answer

    A sudden collapse inside a confined space signals an oxygen-deficient or toxic atmosphere, and most confined-space deaths are would-be rescuers who entered after the first victim. EMTs never enter — only teams with supplied-air breathing apparatus and confined-space training may. An N95 only filters particles and supplies no oxygen, breath-holding fails within seconds, and sending the untrained coworker simply creates another victim.

    Source: NREMT EMT test plan Domain 1: hazard protection and resource requests; OSHA confined-space rescue principle — no entry without supplied air and specialized trainingReport a problem with this question

Practice questions modeled on the National EMS Education Standards and NREMT cognitive-exam content areas. Not medical advice and not affiliated with or endorsed by the National Registry of Emergency Medical Technicians (NREMT) or NHTSA. Always follow your instructor, medical director, and local protocols. Study the official materials at nremt.org. Official NREMT →