2026 Paramedic Trauma Exam Prep:
Practice Questions with Answer Rationales
— Hemorrhage, Shock, Burns, Head
Injuries, Spinal Trauma & Emergency
Management Study Guide
SECTION 1: HEMORRHAGE CONTROL AND TOURNIQUET
MANAGEMENT (Questions 1–20)
Question 1
A paramedic is treating a casualty with a traumatic amputation of the left lower
extremity. The wound is actively bleeding, and the tactical situation is non-
permissive. What is the FIRST intervention?
A. Apply a tourniquet 5–7 cm above the bleeding site
B. Apply direct pressure with a sterile dressing
C. Pack the wound with hemostatic gauze
D. Establish IV access and begin fluid resuscitation
Answer: A
Rationale: For a traumatic amputation with active bleeding, immediate tourniquet
application is the first priority. Current TCCC guidelines recommend placing the
tourniquet 5–7 cm (approximately 2–3 fingers' breadth) above the bleeding site. In
a non-permissive environment, the tourniquet may be applied over clothing. Direct
pressure (B) and wound packing (C) are secondary measures. IV access (D) should
not delay hemorrhage control.
Question 2
A paramedic is applying a tourniquet to a patient with massive extremity
hemorrhage. The bleeding has stopped, but the tourniquet is extremely painful.
What is the appropriate action?
,A. Loosen the tourniquet slightly to relieve pain
B. Administer analgesia and leave the tourniquet in place
C. Remove the tourniquet and apply a pressure dressing
D. Replace the tourniquet with a second tourniquet
Answer: B
Rationale: The tourniquet must remain in place until definitive surgical care. Pain
from tourniquet application is expected and should be managed with analgesia
(e.g., ketamine, fentanyl). Loosening (A) or removing (C) the tourniquet risks re-
bleeding and is contraindicated. Replacing the tourniquet (D) does not address the
pain.
Question 3
According to the 2026 TCCC guidelines, what is the recommended approach to
tranexamic acid (TXA) administration?
A. Administer within 3 hours of injury at 1 g IV over 10 minutes
B. Administer as soon as possible if hemorrhage is suspected, with the 3-hour
window eliminated
C. Administer only after blood products have been given
D. Administer 2 g oral within 1 hour of injury
Answer: B
Rationale: The 2026 TCCC guidelines eliminated the 3-hour cutoff for TXA
administration. TXA should be administered as soon as possible if hemorrhage is
suspected. The previous 1 g IV over 10 minutes (A) and the 3-hour window have
been replaced. Oral administration (D) is not the recommended route.
Question 4
A paramedic is treating a patient with junctional hemorrhage in the groin. Direct
pressure has failed to control bleeding. What is the appropriate intervention?
A. Apply a tourniquet proximally on the thigh
B. Pack the wound with hemostatic gauze and apply sustained direct pressure
C. Apply a pelvic binder at the level of the greater trochanters
D. Perform a fasciotomy
,Answer: B
Rationale: Junctional hemorrhage (groin, axilla, neck) is not amenable to limb
tourniquet application. The appropriate intervention is wound packing with
hemostatic gauze and sustained direct pressure. A tourniquet (A) cannot effectively
control junctional bleeding. A pelvic binder (C) is for pelvic fractures.
Question 5
A paramedic is applying a tourniquet to a patient with a below-knee amputation.
Where should the tourniquet be placed?
A. Directly over the wound
B. 5–7 cm above the bleeding site
C. At the level of the knee joint
D. As proximal as possible on the thigh
Answer: B
Rationale: The tourniquet should be placed 5–7 cm above the bleeding site.
Placing it directly over the wound (A) is ineffective. Placement at a joint (C) is less
effective due to bony prominences. As proximal as possible (D) is reserved for
when the bleeding site is uncertain or the tactical situation does not permit precise
placement.
Question 6
A patient has been treated with a tourniquet for 90 minutes. The tactical situation is
now permissive, and the patient is being evacuated. What is the appropriate action
regarding the tourniquet?
A. Remove the tourniquet to prevent limb ischemia
B. Leave the tourniquet in place and document the application time
C. Loosen the tourniquet every 15 minutes
D. Replace the tourniquet with a pressure dressing
Answer: B
Rationale: Tourniquets should remain in place until the patient reaches definitive
surgical care. The application time must be documented and communicated to the
receiving facility. Removing (A) or loosening (C) the tourniquet risks re-bleeding.
, Question 7
A paramedic is treating a patient with severe external bleeding from the thigh.
Direct pressure and a pressure dressing have failed to control the bleeding. What is
the NEXT intervention?
A. Apply a tourniquet
B. Elevate the extremity
C. Apply a second pressure dressing
D. Administer a vasopressor
Answer: A
Rationale: When direct pressure and pressure dressings fail to control extremity
hemorrhage, a tourniquet is indicated. Elevation (B) and additional pressure
dressings (C) are unlikely to be effective. Vasopressors (D) do not address the
source of bleeding.
Question 8
According to the 2026 TCCC guidelines, what is the proposed tourniquet
reassessment standard?
A. Tourniquets should be reassessed every 30 minutes
B. A 2-hour window for non-medical personnel tourniquet reassessment
C. Tourniquets should never be reassessed in the field
D. Tourniquets should be removed after 1 hour
Answer: B
Rationale: The 2026 TCCC proposed Change 25-2 addresses tourniquet
reassessment standards, including a 2-hour window for non-medical personnel.
This is informed by Russo-Ukrainian War casualty data showing that tourniquets
left on too long during delayed evacuations have cost limbs.
Question 9
A paramedic is applying a tourniquet in a care under fire situation. What is the
appropriate technique?
Practice Questions with Answer Rationales
— Hemorrhage, Shock, Burns, Head
Injuries, Spinal Trauma & Emergency
Management Study Guide
SECTION 1: HEMORRHAGE CONTROL AND TOURNIQUET
MANAGEMENT (Questions 1–20)
Question 1
A paramedic is treating a casualty with a traumatic amputation of the left lower
extremity. The wound is actively bleeding, and the tactical situation is non-
permissive. What is the FIRST intervention?
A. Apply a tourniquet 5–7 cm above the bleeding site
B. Apply direct pressure with a sterile dressing
C. Pack the wound with hemostatic gauze
D. Establish IV access and begin fluid resuscitation
Answer: A
Rationale: For a traumatic amputation with active bleeding, immediate tourniquet
application is the first priority. Current TCCC guidelines recommend placing the
tourniquet 5–7 cm (approximately 2–3 fingers' breadth) above the bleeding site. In
a non-permissive environment, the tourniquet may be applied over clothing. Direct
pressure (B) and wound packing (C) are secondary measures. IV access (D) should
not delay hemorrhage control.
Question 2
A paramedic is applying a tourniquet to a patient with massive extremity
hemorrhage. The bleeding has stopped, but the tourniquet is extremely painful.
What is the appropriate action?
,A. Loosen the tourniquet slightly to relieve pain
B. Administer analgesia and leave the tourniquet in place
C. Remove the tourniquet and apply a pressure dressing
D. Replace the tourniquet with a second tourniquet
Answer: B
Rationale: The tourniquet must remain in place until definitive surgical care. Pain
from tourniquet application is expected and should be managed with analgesia
(e.g., ketamine, fentanyl). Loosening (A) or removing (C) the tourniquet risks re-
bleeding and is contraindicated. Replacing the tourniquet (D) does not address the
pain.
Question 3
According to the 2026 TCCC guidelines, what is the recommended approach to
tranexamic acid (TXA) administration?
A. Administer within 3 hours of injury at 1 g IV over 10 minutes
B. Administer as soon as possible if hemorrhage is suspected, with the 3-hour
window eliminated
C. Administer only after blood products have been given
D. Administer 2 g oral within 1 hour of injury
Answer: B
Rationale: The 2026 TCCC guidelines eliminated the 3-hour cutoff for TXA
administration. TXA should be administered as soon as possible if hemorrhage is
suspected. The previous 1 g IV over 10 minutes (A) and the 3-hour window have
been replaced. Oral administration (D) is not the recommended route.
Question 4
A paramedic is treating a patient with junctional hemorrhage in the groin. Direct
pressure has failed to control bleeding. What is the appropriate intervention?
A. Apply a tourniquet proximally on the thigh
B. Pack the wound with hemostatic gauze and apply sustained direct pressure
C. Apply a pelvic binder at the level of the greater trochanters
D. Perform a fasciotomy
,Answer: B
Rationale: Junctional hemorrhage (groin, axilla, neck) is not amenable to limb
tourniquet application. The appropriate intervention is wound packing with
hemostatic gauze and sustained direct pressure. A tourniquet (A) cannot effectively
control junctional bleeding. A pelvic binder (C) is for pelvic fractures.
Question 5
A paramedic is applying a tourniquet to a patient with a below-knee amputation.
Where should the tourniquet be placed?
A. Directly over the wound
B. 5–7 cm above the bleeding site
C. At the level of the knee joint
D. As proximal as possible on the thigh
Answer: B
Rationale: The tourniquet should be placed 5–7 cm above the bleeding site.
Placing it directly over the wound (A) is ineffective. Placement at a joint (C) is less
effective due to bony prominences. As proximal as possible (D) is reserved for
when the bleeding site is uncertain or the tactical situation does not permit precise
placement.
Question 6
A patient has been treated with a tourniquet for 90 minutes. The tactical situation is
now permissive, and the patient is being evacuated. What is the appropriate action
regarding the tourniquet?
A. Remove the tourniquet to prevent limb ischemia
B. Leave the tourniquet in place and document the application time
C. Loosen the tourniquet every 15 minutes
D. Replace the tourniquet with a pressure dressing
Answer: B
Rationale: Tourniquets should remain in place until the patient reaches definitive
surgical care. The application time must be documented and communicated to the
receiving facility. Removing (A) or loosening (C) the tourniquet risks re-bleeding.
, Question 7
A paramedic is treating a patient with severe external bleeding from the thigh.
Direct pressure and a pressure dressing have failed to control the bleeding. What is
the NEXT intervention?
A. Apply a tourniquet
B. Elevate the extremity
C. Apply a second pressure dressing
D. Administer a vasopressor
Answer: A
Rationale: When direct pressure and pressure dressings fail to control extremity
hemorrhage, a tourniquet is indicated. Elevation (B) and additional pressure
dressings (C) are unlikely to be effective. Vasopressors (D) do not address the
source of bleeding.
Question 8
According to the 2026 TCCC guidelines, what is the proposed tourniquet
reassessment standard?
A. Tourniquets should be reassessed every 30 minutes
B. A 2-hour window for non-medical personnel tourniquet reassessment
C. Tourniquets should never be reassessed in the field
D. Tourniquets should be removed after 1 hour
Answer: B
Rationale: The 2026 TCCC proposed Change 25-2 addresses tourniquet
reassessment standards, including a 2-hour window for non-medical personnel.
This is informed by Russo-Ukrainian War casualty data showing that tourniquets
left on too long during delayed evacuations have cost limbs.
Question 9
A paramedic is applying a tourniquet in a care under fire situation. What is the
appropriate technique?
