Trauma rewards systematic thinking on the NREMT. The candidate who has internalized scene safety → primary survey → bleeding control → rapid transport answers correctly even when the specific injury pattern is unfamiliar. The category accounts for roughly 14 to 18 percent of the exam — about 1 in 6 questions.
This guide walks through the topics tested most often, the numbers worth memorizing, and several sample questions with full rationales.
What's tested in this category
- Hemorrhage control — direct pressure, pressure dressing, tourniquet, wound packing.
- Shock recognition and management — compensated vs decompensated, hypovolemic vs distributive.
- Spinal motion restriction decision-making.
- Burn assessment — rule of nines, depth, criticality.
- Soft tissue injuries — abrasions, lacerations, avulsions, impaled objects, amputations.
- Musculoskeletal injuries — splinting, traction splints, joint injuries.
- Head, face, and neck trauma.
- Chest trauma — rib fractures, flail chest, tension pneumothorax recognition, sucking chest wounds.
- Abdominal and pelvic trauma — pelvic binder use, evisceration management.
- Multisystem trauma and trauma triage criteria.
Numbers and rules worth memorizing cold
- Adult rule of nines: head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%.
- Pediatric rule of nines: head 18%, legs 13.5% each (proportionally larger head, smaller legs).
- Critical burns include: face/airway, hands/feet, genitalia, circumferential, electrical, chemical, full-thickness >5%, partial-thickness >10%.
- Tourniquet — apply 2–3 inches proximal to the wound, tighten until bleeding stops, mark the time.
- Pediatric minimum systolic BP: 70 + (2 × age in years).
- Glasgow Coma Scale: ≤8 = consider advanced airway, 9–12 = moderate TBI, 13–15 = mild TBI.
- Trauma triage 'load and go' criteria include: GCS ≤13, SBP <90, RR <10 or >29, penetrating trauma to head/neck/torso/proximal extremity, flail chest.
Not sure how much of this you actually know? Ten questions gives you a readiness score in about three minutes.
Take the free quizHemorrhage control hierarchy
The single most preventable cause of death in trauma is uncontrolled extremity hemorrhage. The NREMT writes many questions about bleeding control sequence — get this right and you save real points.
- Direct pressure with a gloved hand and gauze.
- Pressure dressing if direct pressure alone doesn't control it.
- Tourniquet for life-threatening extremity hemorrhage that direct pressure won't control. Don't waste time — apply early.
- Wound packing with hemostatic gauze for junctional wounds (groin, axilla, neck) where a tourniquet can't be applied.
Tourniquets are not last resort
Old teaching said tourniquets were last resort due to limb loss risk. Current evidence — much of it from military trauma data — shows early tourniquet use saves lives with very low limb loss risk. If pressure isn't controlling massive extremity bleeding, apply the tourniquet now, not after another minute of pressure.
Sample trauma question
Your turn — pick an answer
A 22-year-old male was shot in the right thigh. There is bright red blood spurting from the wound. You have applied direct pressure for 60 seconds with no decrease in bleeding. The patient is becoming pale and tachycardic. What is your next action?
Rationale
Spurting bright red blood with hemodynamic deterioration is life-threatening arterial hemorrhage that direct pressure has failed to control. The next step is a tourniquet — applied 2–3 inches proximal to the wound, tightened until bleeding stops, and time-marked. Continuing pressure that's not working delays definitive control. Pressure dressing with elevation is reasonable for venous bleeding but inadequate here. Wound packing with hemostatic gauze applies to junctional wounds where a tourniquet can't be placed — the thigh allows a tourniquet.
Sample shock question
Your turn — pick an answer
A 35-year-old female restrained driver in a high-speed crash complains of abdominal pain. Vitals: BP 110/70, HR 124, RR 24, skin pale and cool. Mental status is anxious but oriented. What stage of shock is this patient in?
Rationale
Compensated shock is recognized by tachycardia, tachypnea, anxious mental status, and pale/cool skin — with a still-normal blood pressure. The body is compensating for blood loss by increasing heart rate, respiratory rate, and peripheral vasoconstriction. Hypotension is a late finding; by the time SBP drops, compensatory mechanisms have failed and the patient is in decompensated shock. Recognizing compensated shock early is critical because it's still reversible with rapid transport and definitive care.
Common trauma exam mistakes
- Waiting for hypotension before treating shock — by then, you're behind.
- Skipping scene safety and going straight to the patient at a violent or unstable scene.
- Removing an impaled object — never remove (except in cheek if obstructing airway, or when CPR requires it).
- Ignoring posterior surfaces during head-to-toe — you must log-roll the patient.
- Choosing field treatment over rapid transport for unstable trauma. The fix for hemorrhagic shock is in the operating room, not in your ambulance.
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