Free IBSC MFT practice questions with answers

Twenty-five original, source-verified IBSC MFT questions with full answers and rationale below, free to read, no account required. A new set every day.

1. Question 1

   A crew arrives for an unstabilized antepartum haemorrhage and finds that the sending hospital has faxed records to the receiving centre but has not spoken to anyone there. The receiving centre has not agreed to take the patient. Before this transfer can be an appropriate transfer, the sending hospital must additionally:

   • obtain the receiving facility's agreement to accept the patient and document who accepted itCorrect
   • obtain a bed assignment number from the receiving centre's admitting office
   • confirm that the receiving centre is the closest facility with an obstetric service able to take her
   • obtain written consent from the patient that she agrees to the destination chosen

   Why: The second of the four requirements is that the receiving facility have available space and qualified personnel and have agreed to accept the transfer and provide appropriate medical treatment; CMS adds that the transferring hospital should document the communication, including the date and time of the request and the name and title of the person accepting. Sending records is a separate, third requirement and does not substitute for permission. There is no rule that the destination be the closest obstetric facility, and the patient's written consent is required only when the transfer is being made at her request rather than on a physician certification. A crew that departs on a transfer no one has accepted is carrying a patient whose transfer is not appropriate on its face. Primary reference: State Operations Manual Appendix V (CMS, Rev. 191), Tag A-2409 - Appropriate Transfer, second requirement, p. 62. Cross-reference: 42 CFR 489.24(e)(2)(ii), printed p. 653.

2. Question 2

   In placenta previa, the anatomical problem is that the placenta

   • is supplied by fetal vessels crossing the membranes
   • has separated prematurely from the uterine wall
   • has invaded the myometrium and cannot separate
   • covers part or all of the cervical openingCorrect

   Why: Placenta previa means the placenta covers part or all of the cervical opening, which is why it produces painless bleeding in the late second or third trimester and why it will most likely prevent a vaginal delivery, making surgical capability the destination requirement. Premature separation from the uterine wall with intrauterine bleeding is abruptio placentae. Invasion of the myometrium describes the placenta accreta spectrum, which is a separate listed condition. Fetal vessels crossing the membranes over the cervix is vasa previa, also listed separately and dangerous for a different reason, because the bleeding is fetal. Primary reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Obstetrical and Gynecological Conditions, p. 175. Cross-reference: VA/DoD Clinical Practice Guideline for the Management of Pregnancy (2023), Table 11.2, p. 96.

3. Question 3

   A newborn delivered to a mother with insulin-treated diabetes is being transported with her on a 40-minute leg. Which assessment should the crew specifically add for the infant?

   • A 12-lead electrocardiogram
   • Serial blood pressures in all four limbs
   • A blood glucose measurementCorrect
   • A urine dipstick for ketones

   Why: A maternal history of diabetes is one of the stated reasons to check a blood glucose in the newly born infant, alongside ongoing resuscitation, an ill appearance and inability to feed. In a vehicle that is a cheap, fast test that changes management, whereas nothing else on the list is indicated here: a 12-lead electrocardiogram is not a neonatal transport assessment in this guideline, four-limb pressures are not either, and urine ketones cannot be obtained from an infant in the back of a moving unit and would not be the test used in any case. Primary reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Neonatal Resuscitation, p. 161.

4. Question 4

   Three minutes after an unplanned delivery in the back of an ambulance, a crew member applies the pulse oximeter probe to the newborn's left foot because it is the limb most accessible with the infant on the mother's chest. The reading is likely to be misleading because, in an infant transitioning from fetal circulation, the most accurate saturation is obtained from the:

   • right handCorrect
   • left hand
   • either foot
   • left ear lobe

   Why: The guideline states that measuring pulse oximetry on the right hand provides the most accurate oxygen saturation in infants that are transitioning from fetal to normal circulation. The right hand is the site supplied before the point at which the ductus arteriosus joins the aorta, so it reports blood that has not been mixed with right-to-left ductal flow; a foot or the left side may read lower while the ductus is still shunting, and that difference is a feature of the transition rather than an error. The practical consequence in a moving vehicle is that the convenient limb and the correct limb are often not the same, and the crew has to place the probe where the number means something. The guideline pairs the site with an expected trajectory over the first ten minutes of life, so a site error also invalidates the comparison against that trajectory. Primary reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Neonatal Resuscitation, p. 162. Cross-reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Neonatal Resuscitation, p. 159.

5. Question 5

   Which historical feature is named as a risk factor for gestational diabetes mellitus?

   • A prior infant weighing over nine pounds at birthCorrect
   • A prior delivery complicated by a shoulder presentation
   • A history of a second-trimester pregnancy loss
   • A prior pregnancy complicated by placenta previa

   Why: The named risk factors for gestational diabetes are a prior pregnancy affected by gestational diabetes, a prior delivery of a baby weighing more than nine pounds, being overweight or obese, a family history of diabetes, membership of several specified racial and ethnic groups, and being treated for human immunodeficiency virus; the condition affects about 4 percent of pregnancies. A previous shoulder presentation, a second-trimester loss and a previous previa all appear elsewhere in the same guideline as reasons for advanced obstetric care, but none of them is a gestational diabetes risk factor. Primary reference: VA/DoD Clinical Practice Guideline for the Management of Pregnancy (2023), p. 82.

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7. Question 6

   How many risk factors are required before a pregnancy is treated as at increased risk of pre-eclampsia warranting preventive therapy?

   • Three or more moderate-risk factors, with no high-risk threshold
   • Two or more factors, whether high-risk or moderate-risk
   • One high-risk factor, or two or more moderate-risk factorsCorrect
   • One factor of any kind is sufficient in every case

   Why: The stated threshold is one or more high-risk factors or two or more moderate-risk factors, at which point preventive therapy is offered between 12 and 28 weeks and optimally before 16 weeks, continued daily until delivery. That asymmetry is the whole point of splitting the table: a single high-risk factor such as chronic hypertension counts as much as two moderate ones such as nulliparity with obesity. Requiring two factors of any kind ignores the high-risk column. Accepting any single factor ignores the moderate column's pairing rule. Three moderate factors sets the bar higher than the guideline does. Primary reference: VA/DoD Clinical Practice Guideline for the Management of Pregnancy (2023), p. 81.

8. Question 7

   Which tools are named as validated for screening depression during pregnancy and the postpartum period, and should therefore be the results a crew looks for in a behavioural-health-related maternal transfer record?

   • The quick sepsis-related organ failure assessment and the national early warning score
   • The Edinburgh Postnatal Depression Scale and the 9-item Patient Health QuestionnaireCorrect
   • The Glasgow Coma Scale and the Richmond Agitation-Sedation Scale
   • The Laycock pelvic floor manual muscle test and the Cozean screening tool

   Why: Periodic depression screening with a standardised tool such as the Edinburgh Postnatal Depression Scale or the 9-item Patient Health Questionnaire is a strong recommendation for pregnancy and the postpartum period, and the two scales show high concordance when results are dichotomised into normal and increased risk. A crew reading a transfer record therefore knows which named result is meaningful and which is absent. The quick sepsis assessment and early warning score are sepsis screening tools from a different document. The coma and sedation scales assess consciousness and sedation depth. The pelvic floor muscle test and the Cozean tool screen for pelvic floor dysfunction in the same guideline, not for depression. Primary reference: VA/DoD Clinical Practice Guideline for the Management of Pregnancy (2023), Recommendation 21, p. 61.

9. Question 8

   A patient in a rigid cervical collar after a collision requires intubation before a transfer. Regarding the collar during laryngoscopy, the 2026 airway guideline directs that you:

   • Leave the collar fully in place and accept the restricted view
   • Maintain cervical stabilisation but remove the front of the collarCorrect
   • Remove the collar entirely and abandon cervical precautions
   • Replace the rigid collar with a soft collar before the attempt

   Why: The guideline's rapid sequence induction pathway directs the clinician to maintain cervical spine stabilisation and to remove the front of the cervical collar, and its airway assessment section notes that the neutral position used for cervical stabilisation degrades the laryngoscopic view. The two instructions belong together: the stabilisation is retained while the part of the device that obstructs mouth opening and the view is taken away. Leaving the collar intact accepts a degraded view for no gain. Removing it entirely discards the precaution the mechanism required. A soft collar substitution is not described anywhere in the corpus. The civilian guideline points the other way for the period after intubation, noting that a collar may help reduce neck movement and the risk of tube displacement. Primary reference: JTS Clinical Practice Guideline, Airway Management in Trauma (Joint Trauma System, 28 January 2026), p. 28.

10. Question 9

    A transport team is handing a labouring patient to a receiving unit after a 70-minute transfer during which the fetal heart was monitored. Under AHRQ's fetal monitoring module, the teamwork element that addresses this moment is the use of:

    • transition communication techniques that build a shared mental model of plan and riskCorrect
    • a written summary sent in advance of arrival in place of any verbal report
    • a single nominated clinician who speaks on behalf of the whole transport crew
    • an independent second reading of the monitoring record before any report is given

    Why: AHRQ's teamwork elements for safe electronic fetal monitoring include the use of transition communication techniques to ensure a shared mental model of the plan of care and the perceived risks between shifts or between units, which is precisely the handover a transport team performs. The module pairs that with structured communication in the form of situation, background, assessment and recommendation, together with callouts, huddles and closed-loop communication, and with situational awareness, which it says is particularly relevant where continued surveillance is required before a definitive course of action can be determined. A written summary and a second reading are useful artefacts but neither is the named element, and nominating a single voice is not what the module recommends. AHRQ separately requires standard nomenclature to be used for documenting and communicating monitoring findings, which is what makes a shared mental model possible across an organisational boundary. Primary reference: AHRQ Safety Program for Perinatal Care - Monitoring for Perinatal Safety: Electronic Fetal Monitoring (AHRQ Pub. 17-0003-18-EF, May 2017), Slide 15. Cross-reference: AHRQ Safety Program for Perinatal Care - Safe Medication Administration (AHRQ Pub. 17-0003-19-EF, May 2017), Slide 9.

11. Question 10

    A crew reviews the chart of a patient at 22 weeks before a scheduled transfer. Which single entry, standing alone, places her in the high-risk category for pre-eclampsia rather than the moderate-risk category?

    • A maternal age of 37 years at the estimated date of delivery
    • Nulliparity in a patient otherwise in good health
    • A body mass index above 30 at the first prenatal visit
    • A pregestational diagnosis of type 1 diabetes mellitusCorrect

    Why: The published risk table separates high-risk from moderate-risk factors, and pregestational type 1 or type 2 diabetes sits in the high-risk column with a history of pre-eclampsia, multifetal gestation, chronic hypertension, renal disease and autoimmune disease. Nulliparity, obesity, age 35 or older and in vitro conception are moderate-risk factors. The distinction is not academic for a crew: one high-risk factor, or two moderate-risk factors, is the threshold at which preventive therapy is offered, so it tells the crew how the sending team is already treating her. Primary reference: VA/DoD Clinical Practice Guideline for the Management of Pregnancy (2023), Table 9, p. 81.

12. Question 11

    A group B streptococcus positive patient in labour receives her first dose of intravenous penicillin at 14:10 and the crew departs at 14:25 for a 90-minute transfer. The single fact the receiving team most needs from the handover in order to manage the newborn is:

    • The result of the antenatal vaginal and rectal screening culture
    • The volume of crystalloid infused during the transfer
    • Whether contractions strengthened during the drive
    • The clock time at which the first prophylactic dose was givenCorrect

    Why: CDC defines adequate intrapartum prophylaxis as at least four hours of intravenous penicillin, ampicillin or cefazolin before delivery, and states that all other agents or durations are inadequate for the purposes of neonatal management. A well-appearing infant of any gestational age whose mother received adequate prophylaxis is observed for at least 48 hours with no routine diagnostic testing, while an infant whose mother had an indication but received no or inadequate prophylaxis may need a limited evaluation depending on gestational age and duration of membrane rupture. The newborn pathway therefore turns on an interval the crew alone can document. The infused fluid volume does not enter that pathway. Contraction progress matters obstetrically but does not define adequacy. The screening result explains why she qualifies for prophylaxis, and the receiving hospital already holds it. Primary reference: Prevention of Perinatal Group B Streptococcal Disease, Revised Guidelines from CDC, 2010 (MMWR Recomm Rep 2010;59(RR-10)), printed p. 22.

13. Question 12

    Methylergonovine is given intramuscularly for postpartum uterine atony during a long interfacility transfer. Bleeding slows but does not stop. According to the labelling, what is the dose and the minimum interval before it may be repeated?

    • 0.2 mg, repeated as required at intervals of 2 to 4 hours.Correct
    • 0.2 mg, repeated as required at intervals of 15 to 30 minutes.
    • 1 mg, repeated as required at intervals of 2 to 4 hours.
    • 0.02 mg, repeated as required at intervals of 6 to 8 hours.

    Why: The labelling gives 1 mL containing 0.2 mg intramuscularly after delivery of the anterior shoulder, after delivery of the placenta, or during the puerperium, repeated as required at intervals of 2 to 4 hours. Fifteen to thirty minutes is the repeat window for carboprost rather than for an ergot, and compressing an ergot to that interval stacks a vasoconstrictor. One milligram is five times the labelled dose, and 0.02 mg is a tenth of it. The practical transport consequence is that methylergonovine offers no useful second dose inside a typical transfer window, so a crew whose first dose has not controlled the bleeding needs a different agent rather than a repeat. Primary reference: Methylergonovine Maleate Injection, FDA-approved labelling, DOSAGE AND ADMINISTRATION. Cross-reference: Hemabate (carboprost tromethamine) Sterile Solution, FDA-approved labelling, DOSAGE AND ADMINISTRATION.

14. Question 13

    A patient received subcutaneous terbutaline shortly before a 70-minute transfer. Which cluster of maternal adverse effects does the boxed warning direct the crew to watch for?

    • Tachycardia, hyperglycaemia, hypokalaemia, arrhythmias, pulmonary oedema and ischaemia.Correct
    • Bradycardia, transient hypoglycaemia, hyperkalaemia, heart block and cerebral oedema.
    • Hypertension, hypernatraemia, hypocalcaemia, oliguria and transient cortical blindness.
    • Bronchospasm, hypercapnia, hypothermia, flaccid paralysis and circulatory collapse.

    Why: The boxed warning lists increased heart rate, transient hyperglycaemia, hypokalaemia, cardiac arrhythmias, pulmonary oedema and myocardial ischaemia as the serious maternal adverse reactions reported after terbutaline in pregnant women. These are the predictable consequences of beta-adrenergic stimulation, so the bradycardic, hypoglycaemic and hyperkalaemic mirror image is wrong on mechanism. The hypertension and cortical blindness cluster belongs to severe pre-eclampsia rather than to a beta-agonist. Bronchospasm with flaccid paralysis and circulatory collapse describes magnesium intoxication, and terbutaline is a bronchodilator. Pulmonary oedema is the one a crew is most likely to meet in flight or on a long ground leg, and it is the reason continuous monitoring matters. Primary reference: Terbutaline Sulfate Injection, FDA-approved labelling, WARNING: PROLONGED TOCOLYSIS; PRECAUTIONS. Cross-reference: Magnesium Sulfate in Water for Injection, FDA-approved labelling, ADVERSE REACTIONS.

15. Question 14

    Carboprost tromethamine is chosen for refractory postpartum haemorrhage during transport. Which statement matches its labelled route, single dose and total dose ceiling?

    • 250 micrograms deep intramuscularly, repeatable every 15 to 90 minutes, total 2 mg.Correct
    • 250 micrograms by slow intravenous injection, repeatable every 4 hours, to a total of 2 mg.
    • 1 mg deep intramuscularly, repeatable at 15 to 90 minute intervals, to a total of 12 mg.
    • 250 micrograms subcutaneously, repeatable every 20 minutes, to a total of 1 mg.

    Why: For refractory postpartum uterine bleeding the labelling gives an initial 250 micrograms deep intramuscularly, notes that most successful cases responded to a single injection, allows multiple dosing at intervals of 15 to 90 minutes, and caps the total at 2 mg, which is eight doses. The product is labelled for intramuscular use only, so intravenous and subcutaneous options are both wrong routes. One milligram is four times the single dose, and the 12 mg ceiling belongs to the separate second-trimester abortion indication rather than to haemorrhage. The short repeat window is what makes carboprost usable inside a transport leg, unlike an ergot whose repeat interval is hours. Primary reference: Hemabate (carboprost tromethamine) Sterile Solution, FDA-approved labelling, DOSAGE AND ADMINISTRATION — For Refractory Postpartum Uterine Bleeding. Cross-reference: Methylergonovine Maleate Injection, FDA-approved labelling, DOSAGE AND ADMINISTRATION.

16. Question 15

    A newborn transported after a roadside delivery is crying vigorously with good tone. The hands and feet are dusky blue while the lips, tongue and trunk are pink. This finding is:

    • central cyanosis, which requires positive pressure ventilation without any delay
    • acrocyanosis, a common finding in the newly born infant in transition to extrauterine lifeCorrect
    • a sign of hypothermia alone, which excludes any cardiorespiratory cause of the colour
    • evidence of a right-to-left cardiac shunt requiring urgent paediatric cardiology review

    Why: The guideline records acrocyanosis, a blue discoloration of the distal extremities, as a common finding in the newly born infant transitioning to extrauterine life, and stresses that it must be differentiated from central cyanosis. The distribution is what separates them: blue extremities with a pink trunk, lips and tongue is acrocyanosis, whereas central cyanosis involves the trunk and mucous membranes and is one of the findings that drives the guideline's ventilation and oxygen decisions. So calling this central cyanosis would commit the crew to an intervention this infant does not need. Cold exposure can accentuate the appearance, but the finding does not rule a cardiorespiratory cause in or out on its own, and a structural shunt is not diagnosable from peripheral colour in a vigorous newborn. Primary reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Neonatal Resuscitation, Pertinent Assessment Findings, p. 162. Cross-reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Neonatal Resuscitation, Table 1, p. 161.

17. Question 16

    An unexpected delivery at 33 weeks occurs during a transfer and the only resuscitation mask on the vehicle is clearly too large for the infant. The model guideline's position is that:

    • A supraglottic airway should be placed instead of any mask
    • Ventilation must be deferred until a correctly sized mask arrives
    • Mouth-to-mask ventilation should be substituted for the bag
    • The larger mask may be used, avoiding pressure over the eyesCorrect

    Why: The guideline states that while not ideal, a facemask larger than indicated for the patient's size may be used to provide bag-mask ventilation if an appropriately sized mask is not available, and warns that pressure over the eyes should be avoided because it may result in bradycardia. That is written for exactly this situation, where the kit on board is what the crew has. Deferring ventilation in an apnoeic preterm infant is not an option the guideline offers, and it places bag-mask ventilation with room air at the centre of neonatal resuscitation. Mouth-to-mask ventilation is not described anywhere in the guideline. A supraglottic airway is considered only if bag-mask ventilation is ineffective, and the guideline's own size chart starts at size 1 for neonates up to 5 kg, so a supraglottic device is subject to the same stocking problem. Primary reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Neonatal Resuscitation, p. 162.

18. Question 17

    A crew accepts a 35-minute ground transfer of a newly born infant who required brief ventilation at birth. The ambient temperature in the patient compartment is low and the unit carries no isolette. Beyond drying, covering the head and wrapping the infant, what must the crew also plan to assess en route?

    • Serum sodium, because rewarming shifts free water across compartments
    • Capillary refill time in all four extremities every 5 minutes
    • Deep tendon reflexes, which are depressed by newborn cold stress
    • Blood glucose, because newborn hypothermia leads to hypoglycaemiaCorrect

    Why: Newborns are prone to hypothermia, and the guideline states that hypothermia may lead to hypoglycaemia, hypoxia and lethargy, so it directs that blood glucose be checked and the hypoglycaemia guideline followed. Glucose is also specifically indicated where there is ongoing resuscitation or a maternal history of diabetes. Serum sodium is not obtainable or indicated in this setting. Serial capillary refill is a perfusion trend used in the septic patient, not the reassessment this cold newborn needs. Deep tendon reflexes are the monitoring parameter for magnesium therapy in the mother, not for neonatal cold stress. Primary reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Neonatal Resuscitation, p. 161.

19. Question 18

    A crew is 20 minutes into a 50-minute transfer of a patient at 34 weeks with a twin gestation when the first twin delivers. The second twin remains undelivered and the mother's vital signs are stable. The most appropriate course is to

    • continue toward the receiving facility, since this interval is the window to moveCorrect
    • remain stationary at the roadside until the second twin has delivered and is wrapped
    • return to the originating facility, because twin delivery exceeds a crew's capability
    • divert to the nearest emergency department regardless of its obstetric capability

    Why: The guideline's patient-safety considerations for childbirth state that, if possible, the crew should transport between deliveries when twins are expected, which makes the interval after the first birth the time to cover distance rather than to sit still. Remaining stationary spends that interval and leaves both patients where no further capability exists. Returning to the sending facility abandons the higher level of care the transfer was arranged for, and the guideline's own expectation is that a multiple-gestation delivery calls for additional resources rather than a reversal of the mission. Choosing the nearest facility without regard to its obstetric and neonatal capability is the destination error the guideline warns against by repeatedly specifying the appropriate receiving facility. Primary reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Childbirth, p. 168. Cross-reference: same guideline, Neonatal Resuscitation, p. 162.

20. Question 19

    A patient at 34 weeks with severe pre-eclampsia has a blood pressure of 184/122 en route. What blood-pressure target does the transport guideline set, and why?

    • Whatever pressure the patient's baseline was before pregnancy, however low.
    • Roughly 140/90, to reduce stroke risk while maintaining uterine perfusion.Correct
    • Roughly 110/70, to eliminate any residual risk of maternal haemorrhagic stroke.
    • Roughly 160/100, because lower pressures have no benefit before delivery.

    Why: The transport guideline states that severely elevated pressures must be treated to reduce the risk of maternal stroke but that the goal pressure should be roughly 140/90 to maintain uterine perfusion and keep the fetus well oxygenated, with an initial aim of reducing mean arterial pressure by 20 to 25 percent. Driving the pressure to 110/70 treats the mother's stroke risk at the fetus's expense, since uteroplacental perfusion is pressure dependent and there is no autoregulatory reserve. Leaving it at 160/100 is inside the severe range the guideline defines as requiring treatment. Returning to a prepregnancy baseline is not a target the guideline sets. This is the single most transport-specific antihypertensive decision on the bullet. Primary reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Eclampsia/Pre-Eclampsia, p. 172. Cross-reference: Labetalol Hydrochloride Injection, FDA-approved labelling, DOSAGE AND ADMINISTRATION — Blood Pressure Monitoring.

21. Question 20

    A transport team is ready to depart with an unstabilized patient with severe features of pre-eclampsia. The sending nurse asks the crew to wait forty minutes for a repeat platelet count and liver panel so that the chart is complete. Under CMS's interpretive guidance on the records requirement, the crew should understand that:

    • the transfer may not proceed until every ordered test has been resulted and sent to the receiving hospital
    • a transfer in her interest should not be delayed for pending results, which are telephoned laterCorrect
    • results that are still pending are simply excluded and need not be communicated at all
    • the receiving hospital assumes responsibility for obtaining any records the sender omits

    Why: CMS states that necessary records must accompany the patient, but that if a transfer is in the individual's best interest it should not be delayed until records are retrieved or laboratory results come back; whatever is available at the time of transfer goes with the patient, and results that become available afterwards are telephoned to the receiving hospital and then transmitted. So pending results are neither a reason to hold the ambulance nor something that can simply be dropped. The receiving hospital has duties of its own but the records requirement sits on the transferring hospital. The practical consequence for a crew is that a chart which is incomplete for an understandable reason does not justify a delay in departure. Primary reference: State Operations Manual Appendix V (CMS, Rev. 191), Tag A-2409 - Appropriate Transfer, third requirement, p. 63. Cross-reference: 42 CFR 489.24(e)(2)(iii), printed p. 653.

22. Question 21

    During resuscitation of a patient at 34 weeks in cardiac arrest in the patient compartment, your second crew member is available to help. The model guideline's preferred method of relieving aorto-caval compression is to:

    • Tilt the whole cot to the left by 30 degrees for the remainder of the arrest
    • Have the second rescuer manually displace the uterus to the left while she stays supineCorrect
    • Place a wedge of folded blankets under her right hip and flank
    • Perform compressions with her in the full left lateral position

    Why: The model guideline directs that the patient be positioned supine with a second rescuer performing manual uterine displacement to the left, in order to displace the gravid uterus and increase venous return by avoiding aorto-caval compression. It names left lateral tilt at 30 degrees only as the fallback if manual displacement is unsuccessful, and states expressly that the tilt is less desirable because chest compressions are more difficult to perform in that position. Choosing the tilt first, or a blanket wedge that produces the same tilt, therefore trades compression quality for a result manual displacement achieves without that cost. Full left lateral positioning makes effective compressions harder still. Primary reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Cardiac Arrest, p. 122. Cross-reference: National Model EMS Clinical Guidelines, Version 3.0, Childbirth, p. 168.

23. Question 22

    Which of the following is a labelled contraindication to tranexamic acid injection?

    • Subarachnoid haemorrhage, because of the risk of cerebral oedema and cerebral infarction.Correct
    • Pre-eclampsia, because tranexamic acid raises mean arterial pressure.
    • A platelet count below 100,000 per microlitre, because bleeding time is prolonged.
    • Concurrent magnesium sulfate infusion, because of additive neuromuscular depression.

    Why: The labelling contraindicates tranexamic acid in patients with subarachnoid haemorrhage because of the risk of cerebral oedema and cerebral infarction, alongside neuraxial administration, active intravascular clotting and severe hypersensitivity. Pre-eclampsia is not a contraindication and tranexamic acid is not described as raising blood pressure; hypotension is the listed adverse effect. Thrombocytopenia is not listed, and as an antifibrinolytic the drug stabilises clot rather than prolonging bleeding time. No interaction with magnesium appears. The subarachnoid contraindication is genuinely relevant in maternal transport, because a severely hypertensive pre-eclamptic patient with a thunderclap headache and focal deficit may be having an intracranial bleed rather than an obstetric one. Primary reference: Tranexamic Acid Injection, FDA-approved labelling, CONTRAINDICATIONS; WARNINGS AND PRECAUTIONS — Thromboembolic Risk. Cross-reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Eclampsia/Pre-Eclampsia, p. 171.

24. Question 23

    During pre-departure planning for a 95-minute ground transfer, a sending intensivist proposes starting a new vasoactive infusion once the ambulance is moving so that titration can be observed over the leg. Under the interfacility transport operational guideline, the crew should recognise that:

    • starting the infusion en route is preferred, because titration is easier once the vehicle is at a steady speed
    • the planned initiation of new interventions en route is discouraged; treatments should be steadyCorrect
    • the decision belongs to the receiving intensivist rather than to the sending intensivist
    • the infusion may be started en route provided a second clinician records every change

    Why: The guideline's stabilization section says that treatments other than resuscitative measures should be at steady state, not requiring dynamic, complex or life-preserving adjustment en route, and that until technology progresses the planned initiation of new interventions, or the continuation of complex or capability-unique interventions, during transport is discouraged. The reasoning is environmental rather than pharmacological: noise, vibration and cramped space degrade monitoring and dislodge equipment, so a titration that is straightforward at the bedside is not straightforward in a moving vehicle. Anticipated deterioration is instead to be prevented before departure with risk-mitigation steps such as placing lines or tubes. A second recorder does not change the recommendation, and the decision is the transferring provider's. Primary reference: JTS/CoERCCC Operational Guideline, Interfacility Transport of Patients Between Medical Treatment Facilities (12 Dec 2025), Patient Stabilization, p. 4. Cross-reference: JTS CPG En Route Care Patient Packaging (ID 97, 21 Aug 2024), Pearls of Preparation, p. 5.

25. Question 24

    A gravid patient in respiratory failure is placed on non-invasive ventilation for a transfer and becomes anxious and restless. What does the transport guideline say about sedating her?

    • Routine sedation with a short-acting opioid is recommended before the mask is applied to the patient's face.
    • Routine sedation is recommended only in patients beyond 34 weeks' gestation, when reserve is lowest.
    • Routine sedation is not recommended; the anxiety is presumed hypoxic and treated with ventilatory support.Correct
    • Routine sedation with a benzodiazepine is recommended to improve mask tolerance and reduce the work of breathing.

    Why: The transport guideline states that routine use of sedation is not recommended for treatment of anxiety in patients on non-invasive ventilation, and that anxiety should be presumed due to hypoxia or inadequate minute ventilation and treated primarily with ventilatory support. Sedating with a benzodiazepine or an opioid to improve mask tolerance treats the symptom while the cause worsens, and in a patient whose respiratory reserve is already reduced it risks the airway the crew is trying to avoid instrumenting. Gestational age does not change the principle. This matters in maternal transport because a breathless pre-eclamptic patient with pulmonary oedema is a common presentation and the reflex to sedate her is strong. Primary reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Airway Management, p. 182. Cross-reference: Labetalol Hydrochloride Injection, FDA-approved labelling, CONTRAINDICATIONS.

26. Question 25

    A patient at 30 weeks is bleeding vaginally during a ground transfer and the crew wants to judge the volume and the source. Which action is specifically excluded here?

    • Weighing the saturated pads to quantify the loss
    • Examining the abdomen for distension, tenderness and rigidity
    • Establishing large-bore intravenous access and giving crystalloid
    • A digital vaginal examination to identify the source of bleedingCorrect

    Why: The guideline states that a hand or fingers should not be placed into the vagina of a bleeding patient except for a prolapsed cord or a breech birth that is not progressing. In a patient who may have a placenta previa, that restriction is what protects her from catastrophic bleeding, and it holds whether the crew is at a bedside or in a vehicle. The other three actions are all expected: the abdominal examination for distension, tenderness and rigidity is part of the secondary survey in this presentation, large-bore access with crystalloid is the directed treatment where there are signs of shock, and quantifying rather than eyeballing the loss is what prevents the underestimation that delays recognition of haemorrhage. Primary reference: National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Obstetrical and Gynecological Conditions, p. 176. Cross-reference: AHRQ Safety Program for Perinatal Care, Labor and Delivery Unit Safety (AHRQ Pub. 17-0003-21-EF, May 2017), p. 14.