Free IBSC WP-C practice questions with answers

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

1. Question 1

   A remote clinic team responding to an avalanche has far more critically injured patients than they can treat with the personnel and supplies on hand. One patient has massive head and spinal injuries clearly incompatible with survival even with full resources. Under the resource-based expectant category described in mass-casualty guidance, when is it appropriate to categorize a patient this way?

   • Only after a physician has personally examined every patient at the scene
   • Whenever a single patient is severely injured, regardless of overall resource availability
   • Whenever the team is more than two hours from the nearest hospital
   • Only when the requirements to adequately treat all patients exceed the resources actually availableCorrect

   Why: The expectant category is used only in situations where the requirements to adequately treat these patients exceed the resources available; outside that resource-limited condition, guidance states that patients are generally assumed to have a chance of survival. Injury severity alone (A) does not trigger the category without a genuine resource mismatch, distance to a hospital (C) is not the criterion described, and a mandatory physician exam (D) is not a stated requirement for the classification.

2. Question 2

   During a wilderness team's post-incident review, a member who made an honest, unintentional documentation lapse under chaotic conditions is treated very differently from a member who was found to have deliberately ignored a known safety procedure. What organizational principle explains that distinction?

   • An anonymous-only policy, under which no distinction between error types is ever made or recorded
   • A zero-tolerance policy, under which any deviation from procedure results in the same disciplinary outcome
   • A strict seniority rule, under which only the most junior team member present is ever held accountable for any error, regardless of who actually decided
   • A just-culture approach, which identifies systemic causes of honest error while still holding reckless or willfully noncompliant conduct accountableCorrect

   Why: A just-culture approach draws exactly this line: it treats honest error as a systemic issue to investigate and correct without fear of reprisal, while still exhibiting intolerance for recklessness or willful disregard of established procedures. It is not a blanket zero-tolerance rule, is not based on seniority, and does not mean every incident is treated identically regardless of intent. Primary reference: Safety Management Systems for Aviation Service Providers (Federal Aviation Administration, AC 120-92B, 8 Jan 2015), Safety Culture and Safety Management, p. 7. Cross-reference: Helicopter Air Ambulance Operations (Federal Aviation Administration, AC 135-14B, 26 Mar 2015), Appendix B, p. 71.

3. Question 3

   A patient sustains a penetrating spinal injury from a fall onto exposed rebar, with contamination of the wound tract by a hollow-viscus structure. How long should broad-spectrum antibiotic coverage continue for this contaminated penetrating spine injury?

   • A single one-time dose is sufficient in every case, since penetrating spine wounds have inherently low infection risk
   • 48 hours to 10 days, depending on the degree of contamination and control of any cerebrospinal fluid leakCorrect
   • 24 hours only, matching the standard prophylaxis duration used for a clean elective surgical incision
   • Antibiotics are not indicated for spine injuries at all, regardless of contamination level or CSF leak

   Why: Patients with concomitant hollow-viscus injuries and penetrating spinal cord injuries should receive broad-spectrum antimicrobial coverage for 48 hours to 10 days, with duration depending on the level of wound contamination and whether any CSF leak is controlled. A single dose or a flat 24-hour clean-incision course understates the infection risk from hollow-viscus contamination, and withholding antibiotics entirely ignores the guideline's explicit recommendation. Primary reference: Cervical and Thoracolumbar Spine Injury Evaluation, Transport and Surgery in the Deployed Setting (Joint Trauma System Clinical Practice Guideline ID 15, 19 Jun 2020), p. 13. Cross-reference: Acute Traumatic Wound Management in Prolonged Field Care (Joint Trauma System Clinical Practice Guideline ID 62, 24 Jul 2017), p. 10.

4. Question 4

   A search dog's paw laceration is being bandaged daily during a multi-day field operation. Per current canine wound management guidance, which bandaging practice is no longer recommended as the standard of care?

   • Using an Elizabethan collar or improvised cone to stop the dog chewing the bandage
   • Moisture retentive dressings that support moist wound healing
   • Wet-to-dry (adherent) bandaging, due to the indiscriminate debridement it causesCorrect
   • Changing the bandage daily, or more often if discharge is heavy

   Why: Current guidance states that wet-to-dry (adherent) bandages are no longer recommended because the indiscriminate debridement they cause compromises wound healing, and identifies moisture retentive dressings supporting moist wound healing as the current standard of care instead; daily bandage changes (more often with heavy discharge) and an e-collar or improvised cone to prevent self-trauma remain recommended practices. Primary reference: Wound Management (K9 CPG:14) (Joint Trauma System Clinical Practice Guideline, 18 Dec 2025), Bandaging Recommendations, p. 4.

5. Question 5

   A diver ascending from a remote quarry dive develops sharp ear pain that he attempts to relieve by pinching his nose and blowing hard, the same maneuver that worked on the way down. What should he have done instead?

   • Stop, descend a few feet, and let the ear vent before continuing a slower ascent.Correct
   • The same forceful Valsalva maneuver, performed twice as hard to overcome the blocked passage
   • A rapid full ascent to the surface to equalize all at once
   • Vigorous jaw movement and swallowing performed while continuing to ascend at the same rate

   Why: During ascent, trapped gas in the middle ear expands and normally vents passively through the eustachian tube; if the tube is blocked, a Valsalva maneuver only adds more gas to an already overpressurized space and can worsen the overpressure or provoke an arterial gas embolism, so it is never performed on ascent. The correct response to ear pain or vertigo during ascent is to halt, descend a few feet to relieve the pressure, and then continue upward more slowly, repeating as needed. A rapid full ascent risks pulmonary overinflation injury, and continuing to ascend at the same rate while trying to clear does not relieve the overpressure. Primary reference: U.S. Navy Diving Manual, Revision 7 (Naval Sea Systems Command, 01 December 2016), Chapter 3, Middle Ear Overpressure, pp. 188-189.

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7. Question 6

   During a long carry-out with an intubated patient, the team periodically checks and adjusts the endotracheal cuff pressure with a manometer. What target cuff pressure should they aim for?

   • 5 mmHg
   • 20 mmHgCorrect
   • 100 mmHg
   • 60 mmHg

   Why: The guideline directs periodic cuff-pressure checks with a manometer to a goal of about 20 mmHg, which avoids both an under-inflated cuff that risks aspiration and leak, and an over-inflated cuff that risks tracheal mucosal injury over a prolonged carry; 5 mmHg would likely leak, and 60 or 100 mmHg would risk pressure injury. Primary reference: Prolonged Casualty Care Guidelines (Joint Trauma System, 21 December 2021), Airway Management - PCC, Role 1c, p. 14. Cross-reference: Airway Management in Trauma (Joint Trauma System, 28 January 2026), Post Cricothyrotomy/Endotracheal Intubation Checklist, p. 23.

8. Question 7

   A team is scouting a ridge-top helispot for a Type 1 (heavy) helicopter to extract a critically injured climber. Using NWCG fixed-helispot standards, what touchdown pad dimensions should the team prepare?

   • 30 feet by 30 feet, clear and level, inside a 110-foot safety circleCorrect
   • 15 feet by 15 feet, clear and level, inside a 75-foot safety circle marked for the smallest helicopter type
   • 20 feet by 20 feet, clear and level, inside a 90-foot safety circle sized for a medium helicopter
   • 50 feet by 50 feet, clear and level, with no defined safety circle required by the guide

   Why: NWCG fixed-helispot standards scale with helicopter type: Type 1 (heavy) helicopters need a 30-foot by 30-foot clear, level touchdown pad within a 110-foot safety circle, larger than the 20x20/90-foot standard for Type 2 or the 15x15/75-foot standard for Type 3 aircraft; no helispot standard omits a safety circle. Primary reference: Incident Response Pocket Guide, PMS 461 (National Wildfire Coordinating Group, January 2025), Helicopter Landing Area Selection, p. 82.

9. Question 8

   A WP-C provider is preparing a written handoff report before an arriving helicopter crew takes over an injured hiker's care. Which set of elements should that structured handoff summarize?

   • Overall patient condition and trend, mechanism/injury, current exam, vital sign trends and output, and treatments givenCorrect
   • Only the patient's name, age, and the time the incident was first reported to dispatch
   • A list of everyone who touched the patient during the rescue, in the exact order each person arrived on scene, regardless of what care any of them gave
   • The estimated cost of the rescue and which agencies will be billed for the response

   Why: A structured handoff should summarize the patient's overall condition and whether it is improving or worsening, the mechanism of injury or illness, current physical exam findings, vital sign trends including urine output, and the treatments already given. Demographic details alone, a roster of who touched the patient, or billing information are not what makes a handoff clinically useful to the next team. Primary reference: Documentation in Prolonged Field Care (Joint Trauma System Clinical Practice Guideline ID 72, 13 Nov 2018), Handoff Report, p. 5. Cross-reference: Tactical Combat Casualty Care Guidelines for Medical Personnel (Committee on TCCC / Joint Trauma System, 01 May 2026), Documentation of Care, p. 13.

10. Question 9

    As a wilderness medical team begins caring for a critically ill patient over what is likely to be a multi-hour prolonged field care situation, what is one of the first organizational steps recommended before diving into detailed clinical tasks?

    • Naming a team leader who manages the clinical picture while others handle focused tasksCorrect
    • Assigning every team member to perform the exact same tasks in parallel, so that nothing is ever missed
    • Deferring all role assignment entirely until after the patient's condition has fully stabilized
    • Rotating the leadership role every fifteen minutes specifically to prevent any one person from becoming fatigued

    Why: Delineating roles and naming a team leader early is recommended specifically so one person can manage the larger clinical picture while others concentrate on attention-intensive individual tasks without everyone trying to track everything at once. Assigning duplicate parallel tasks, delaying role assignment until after stabilization, or rotating leadership every few minutes would each undermine the continuity of oversight this structure is meant to protect. Primary reference: Prolonged Casualty Care Guidelines (Joint Trauma System Clinical Practice Guideline ID 91, 21 December 2021), Prolonged Casualty Care Principles, p. 7.

11. Question 10

    A patient on supplemental oxygen is being prepared for a long, helicopter-delayed ground evacuation with a limited oxygen supply. While still in a controlled setting on the ground, what does en route care preparation guidance recommend doing with the patient's oxygen requirement before departure, if the patient's condition allows it?

    • Switch the patient onto room air entirely before any part of the transport begins, regardless of status
    • Increase the fraction of inspired oxygen to 100 percent for the entire ground preparation period, no matter the remaining supply
    • Decrease the oxygen requirement on the ground to conserve supply and allocate it properly en routeCorrect
    • Oxygen settings should never be adjusted before transport begins, under any circumstance whatsoever

    Why: Preparation guidance recommends decreasing the fraction of inspired oxygen requirement in the controlled ground setting, where it is safe to do so, in order to conserve limited resources and ensure proper allocation once the patient is moving. Increasing to 100 percent runs opposite to the conservation goal; refusing to ever adjust oxygen before transport contradicts the explicit recommendation to do so; and switching entirely to room air is a more extreme step than what is actually recommended and could be unsafe. Primary reference: En Route Care (ERC) Patient Packaging (Joint Trauma System Clinical Practice Guideline ID 97, 21 August 2024), Pearls of Preparation, p. 4.

12. Question 11

    A ventilated patient with a known history of reactive airway disease shows a capnography value trending upward past 45 mmHg over the course of a long transport. What should this trend prompt the team to consider?

    • A completely normal finding in an anxious, hyperventilating patient
    • A value that is only clinically meaningful during active cardiac arrest
    • Worsening ventilation, which can reflect progressing obstructive airway disease and signals a need for more active ventilatory supportCorrect
    • Confirmation that spontaneous circulation has just returned

    Why: A rising end-tidal CO2 above 45 mmHg indicates the patient is retaining CO2 and ventilating less effectively, with worsening obstructive disease listed among the possible causes, prompting consideration of more active ventilatory assistance; it is not a normal finding in hyperventilation (which lowers ETCO2), it is meaningful outside of cardiac arrest, and it does not by itself confirm return of circulation. Primary reference: Airway Management in Trauma (Joint Trauma System, 28 January 2026), ETCO2 & Other Equipment, p. 12.

13. Question 12

    A client with a history of coronary artery disease and a recent stent placement is finalizing medications before a multi-week expedition. According to chronic-illness travel guidance, what general principle applies to this client's cardiac medications in the weeks immediately before departure?

    • Medications should remain unchanged for at least two weeks before long-distance travelCorrect
    • Medication timing should be shifted forward by twelve hours starting the day before travel begins
    • All cardiac medications should be stopped one week before departure to avoid interactions with field drugs
    • Doses should be doubled in the final week to build a buffer against missed doses in the field

    Why: Guidance for travelers with recent cardiac events or procedures specifies that medications should remain unchanged for at least two weeks before long-distance travel, reflecting the goal of a stable, predictable regimen going into a trip where access to a treating cardiologist will be limited. Stopping medications, doubling doses, or shifting the timing by half a day are not the stability-focused recommendation this guidance makes. Primary reference: CDC Health Information for International Travel (Yellow Book, 2026 edition), "Travelers with Chronic Illnesses" (Centers for Disease Control and Prevention, 2026), section "Specific chronic medical conditions" (Table 2.4.2, Cardiovascular and Other Cardiocirculatory Disorders).

14. Question 13

    A patient with a spinal cord injury from a fall is expected to be immobile for several days awaiting evacuation. Mechanical compression devices are not available. What chemoprophylaxis approach is appropriate?

    • Withhold all chemoprophylaxis entirely until the patient reaches a hospital with imaging available
    • Start prophylactic low molecular weight heparin as soon as possible, and within 72 hours of injuryCorrect
    • Start full therapeutic-dose, not prophylactic, heparin immediately regardless of the bleeding risk
    • Delay all chemoprophylaxis for two full weeks to allow the fracture site to stabilize first

    Why: An aggressive DVT prophylaxis regimen should start early, with prophylactic-dose LMWH or fixed low-dose unfractionated heparin initiated as soon as possible and definitely within 72 hours of injury. Withholding prophylaxis or delaying it for weeks leaves an immobile patient at high thromboembolic risk, and therapeutic-dose anticoagulation is not the recommended prophylactic strategy and carries added bleeding risk. Primary reference: Cervical and Thoracolumbar Spine Injury Evaluation, Transport and Surgery in the Deployed Setting (Joint Trauma System Clinical Practice Guideline ID 15, 19 Jun 2020), p. 11.

15. Question 14

    A volunteer who has been standing at a trailhead check-in station for an hour in the sun suddenly feels lightheaded and briefly loses consciousness, then recovers within a minute of sitting down. Skin is warm and flushed, but there is no history of exertion. What is the most likely explanation?

    • Heat syncope from blood pooling in the lower-extremity veins during prolonged standingCorrect
    • Exertional heat stroke, since any collapse in a hot environment should be treated as heat stroke until proven otherwise
    • Exercise-associated hyponatremia, since she may have overhydrated while waiting
    • Heat cramps progressing to loss of consciousness from severe electrolyte depletion

    Why: Prolonged standing in a hot environment allows blood to pool in dilated leg veins, reducing venous return and cerebral perfusion enough to cause brief lightheadedness or fainting; core temperature is usually not significantly elevated unless the episode follows real exertion, and recovery is typically rapid once the person is supine or seated. Labeling every hot-environment collapse as heat stroke ignores the absence of exertion, hyperthermia, or mental-status change here; hyponatremia requires a history of substantial fluid overload rather than mere standing; and heat cramps are a localized muscular problem, not a cause of syncope. Primary reference: TB MED 507, Heat Stress Control and Heat Casualty Management (Headquarters, Department of the Army, 12 April 2022), chapter 4, p. 45. Cross-reference: NIOSH Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments (DHHS (NIOSH) Publication 2016-106), Table 4-3, p. 80-81.

16. Question 15

    A patient with a Foley catheter is being cared for at a remote base camp during a multi-day evacuation delay, and the team has no graduated collection container. What is an acceptable minimum-standard way to measure the patient's urine output with what is likely already in camp?

    • Disconnect the Foley bag and let the urine drain onto the ground so no measurement error can occur
    • Stop tracking urine output entirely and simply wait until a proper graduated cylinder becomes available
    • Estimate output by counting how many times the patient reports the urge to void, without collecting any fluid at all
    • Collect drainage in an empty water bottle and estimate the volume against its known capacityCorrect

    Why: Field guidance for intake and output monitoring accepts an available container, such as an empty water bottle, as the minimum standard for collecting and estimating urine output when no graduated cylinder is present, since common containers have a known approximate volume that can be used for estimation. Abandoning output tracking, estimating from reported urges without collecting fluid, or discarding the output without measurement all forfeit clinically useful trend data that a remote care plan depends on. Primary reference: Nursing Interventions, Wound Care, and Splint Management in Prolonged Casualty Care (Joint Trauma System Clinical Practice Guideline ID 70, 08 July 2025), Improvised urine output collection, p. 8. Cross-reference: Prolonged Casualty Care Guidelines (Joint Trauma System Clinical Practice Guideline ID 91, 21 Dec 2021), Improvised urine output collection using a Nalgene-type bottle, p. 50.

17. Question 16

    A trailhead incident involves several injured hikers, but the threat (a still-unstable rockslope) has been fully controlled, medical personnel are already on scene, evacuation is possible, and resources are not severely limited. Which MASCAL triage class best fits this incident?

    • Triage Class 3 / Ultra-MASCAL, because the threat is ongoing and resources are severely limited
    • No formal class applies, because this trailhead incident does not involve enough patients or fatalities to qualify as a true MASCAL
    • Triage Class 1, with adequate medics to treat the critical patients and handle the restCorrect
    • Triage Class 2, because casualties are numerous and resources are very limited

    Why: Triage Class 1 is defined by adequate medical personnel to treat the critical patients and handle the rest, a controlled threat, resources that are not severely limited, and evacuation that is possible — matching this scenario point for point. Class 2 (B) requires resources to be very limited, and Class 3 (C) requires an ongoing threat with severely limited resources, neither of which fits a controlled slope with adequate staffing; the classification framework applies regardless of exact patient count (D), since it is built on the balance between casualties and available capability rather than a fixed number.

18. Question 17

    An unconscious patient is being cared for on a cot at a remote camp for an extended period awaiting evacuation. Aside from the routine repositioning schedule, what additional positioning measure does field nursing guidance specifically recommend to reduce this patient's risk of developing pneumonia?

    • Placing the patient prone for the majority of each day
    • Elevating the head of the bed to about 30 degrees whenever possible, even using rolled blankets as an improvised wedgeCorrect
    • Keeping the patient completely flat at all times to avoid any aspiration risk
    • Elevating only the feet, with the head kept level with the body

    Why: Field nursing guidance recommends elevating an unconscious patient's head of bed to about 30 degrees, using rolled blankets or a wedge if nothing else is available, specifically because this reduces the risk of pneumonia during prolonged immobility. Keeping the patient completely flat removes that protective elevation rather than providing it, elevating only the feet does not address the aspiration mechanism the head elevation targets, and the guidance does not direct routine prone positioning for this purpose. Primary reference: Nursing Interventions, Wound Care, and Splint Management in Prolonged Casualty Care (Joint Trauma System Clinical Practice Guideline ID 70, 08 July 2025), Head-of-bed elevation to reduce pneumonia risk, p. 10.

19. Question 18

    A hiker on a remote desert trail is bitten by a snake she cannot identify and did not see clearly. Her partner wants to hike back to try to find and kill the snake so a clinician can identify it later. What should the wilderness paramedic do?

    • Focus on the patient's evolving signs and symptoms and begin treatment based on the envenomation syndrome she develops, not on the snake's identityCorrect
    • Send the partner to locate and kill the snake so species identification can guide antivenom choice before any treatment begins
    • Withhold any treatment until a photograph of the snake confirms whether it was venomous
    • Apply a tourniquet proximal to the bite while someone attempts to track the snake for identification

    Why: Venomous snakebite management is driven by the clinical syndrome the patient develops (neurotoxic, hemotoxic, cytotoxic, or systemic instability), not by identifying the species. Chasing or killing the snake wastes time and risks a second bite, and the guideline explicitly instructs providers not to try to identify the snake. A tourniquet is contraindicated regardless. The correct action is to focus assessment and treatment on the patient's signs and symptoms as they evolve.

20. Question 19

    A wilderness paramedic is titrating bag-valve-mask ventilations for a patient during a prolonged carry. To improve the patient's minute ventilation without changing the rate at which she is bagging, what should she adjust?

    • The tidal volume delivered with each breathCorrect
    • The oxygen concentration in the reservoir bag
    • The size of the mask seal
    • The angle of the patient's cervical collar

    Why: Minute ventilation is defined as respiratory rate multiplied by tidal volume, so with rate held constant, increasing the tidal volume delivered per breath is the only listed option that changes minute ventilation and therefore gas exchange. Oxygen concentration affects oxygenation rather than minute ventilation, mask seal quality affects delivery efficiency rather than the ventilation variable itself, and collar angle does not enter the minute-ventilation equation at all. Primary reference: Prolonged Casualty Care Guidelines (Joint Trauma System Clinical Practice Guideline ID 91, 21 December 2021), Respiration and Ventilation, p. 16.

21. Question 20

    A search-and-rescue medic is caring for a patient with a head injury several days from the trailhead. Over several hours the patient's neurologic exam worsens from mild to moderate traumatic brain injury. How should this change the team's evacuation-destination planning?

    • Destination planning should not change, since all receiving facilities can stabilize head injuries equally
    • The team should upgrade evacuation priority and request a facility with neurosurgical capability, rather than simply the nearest hospitalCorrect
    • The team should continue toward the originally planned nearest facility regardless of the patient's trajectory
    • The team should wait until they arrive at the nearest facility before ever considering whether a transfer to a higher-capability center might be needed

    Why: Guidance for a deteriorating traumatic brain injury specifically calls for upgrading evacuation priority and destination to a facility with neurosurgical capability once the injury moves from mild toward moderate or severe. Assuming all facilities are interchangeable, deferring the capability question until arrival, or sticking with a plan made before the deterioration all risk delivering the patient to a facility that cannot definitively treat the injury. Primary reference: Prolonged Casualty Care Guidelines (Joint Trauma System Clinical Practice Guideline ID 91, 21 December 2021), p. 27.

22. Question 21

    A field team lead can normally approve routine route changes on her own authority. She is now facing a decision with a much higher potential consequence: whether to commit the whole team to an overnight bivouac on an exposed ridge rather than retreat. According to how risk acceptance authority is typically structured, what should determine who is allowed to make this call?

    • The field lead should always make the call herself no matter the stakes, simply because she happens to be the person on scene
    • The decision should instead be made by whichever team member has been with the organization the longest, regardless of role
    • The decision should be elevated to a more senior person because the magnitude of risk has increasedCorrect
    • The decision should be deferred entirely to whoever originally requested the mission be carried out

    Why: Who is authorized to accept a risk is meant to scale with how much risk is actually on the table: routine, low-consequence choices can be made at the field level, but a higher-magnitude decision is elevated to someone with broader authority and perspective. Seniority by tenure alone, always deferring to the person on scene regardless of stakes, and handing the call to whoever requested the mission all substitute a different rule for the one that actually governs risk acceptance. Primary reference: Advisory Circular AC 120-92B, Safety Management Systems for Aviation Service Providers (US Federal Aviation Administration, January 8, 2015), Chapter 3, Safety Risk Management, p. 30. Cross-reference: Advisory Circular AC 135-14B, Helicopter Air Ambulance Operations (US Federal Aviation Administration, March 26, 2015), Chapter 2, Formal Risk Analysis, p. 25.

23. Question 22

    A wilderness paramedic staffing an expedition base camp has only a manual blood pressure cuff, stethoscope, and pulse oximeter for a patient in shock. Per prolonged field care monitoring guidance, which single additional piece of equipment would move her monitoring capability from the minimum tier to the better tier?

    • A twelve-lead ECG monitor
    • A portable point-of-care lactate analyzer
    • A Foley catheter with a graduated collection bag
    • A capnometer to display end-tidal CO2Correct

    Why: Prolonged field care monitoring guidance defines the minimum tier as blood pressure cuff, stethoscope, and pulse oximeter with vital-sign trend documentation, and the better tier as adding capnometry to that minimum set. A 12-lead ECG and a lactate analyzer belong to more advanced capability sets not specified as the better-tier addition, and a Foley catheter addresses urine output monitoring rather than the vital-signs tier itself. Primary reference: Damage Control Resuscitation in Prolonged Field Care (Joint Trauma System Clinical Practice Guideline ID 73, 1 October 2018), Monitoring, p. 9. Cross-reference: Prolonged Casualty Care Guidelines (Joint Trauma System Clinical Practice Guideline ID 91, 21 December 2021), Pain Management, p. 37.

24. Question 23

    A guide on a hot slickrock traverse is estimating how much a 2% loss of body weight from unreplaced sweating will affect a client's tolerance of the heat over the rest of the day. What is the most accurate expectation?

    • A 2% body-weight water deficit has no measurable physiologic effect until it reaches roughly 8% of body weight
    • Body-weight water deficits only matter for cardiovascular strain, not for core temperature regulation
    • A 2% body-weight water deficit primarily affects cognitive performance and has little effect on physical work capacity, since thermoregulation is not disrupted until much larger deficits accumulate
    • Even a modest 2% body-weight water deficit measurably raises core temperature and cardiovascular strain and begins to impair work performanceCorrect

    Why: Dehydration raises core temperature by roughly a third of a degree Fahrenheit and adds roughly five extra heartbeats per minute for every one percent of body weight lost as unreplaced sweat, so a 2% deficit already begins to impair performance, and effects become more dramatic by about 4%. This means real physiologic and performance costs start well before any severe, life-threatening deficit, and the effect is not limited to just one physiologic system since both thermoregulation and cardiovascular strain worsen together. Primary reference: TB MED 507, Heat Stress Control and Heat Casualty Management (Headquarters, Department of the Army, 12 April 2022), chapter 2, p. 17. Cross-reference: NIOSH Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments (DHHS (NIOSH) Publication 2016-106), hydration discussion, p. 61.

25. Question 24

    Two patients are being resuscitated during a prolonged evacuation from a remote hunting camp: one has isolated hemorrhagic shock from a leg wound, and the other has a severe head strike with suspected traumatic brain injury. How should their systolic blood pressure resuscitation goals differ?

    • Both should share the same systolic goal of about 90 mmHg
    • The TBI patient's pressure goal should run lower, to limit bleeding
    • Blood pressure goals no longer apply once evacuation begins
    • The TBI patient's pressure goal should run higher, above 110 mmHgCorrect

    Why: Guidance sets the goal systolic blood pressure at approximately 100 mmHg for patients being resuscitated with blood products, but raises the goal to greater than 110 mmHg specifically for patients with traumatic brain injury, because adequate cerebral perfusion pressure outweighs the mild-hypotension strategy used to limit ongoing hemorrhage in isolated trauma. Treating both patients identically, or deliberately lowering the TBI patient's goal, would risk secondary brain injury from inadequate perfusion, and blood pressure targets remain relevant throughout a prolonged evacuation. Primary reference: Damage Control Resuscitation in Prolonged Field Care (Joint Trauma System Clinical Practice Guideline ID 73, 1 October 2018), End Points of Resuscitation, p. 11.

26. Question 25

    At a backcountry clinic tent, a wilderness paramedic is preparing to give antivenom to a patient with a confirmed envenomation. The only antivenom product on hand carries package labeling that allows intramuscular injection. What route should actually be used?

    • Intramuscular injection only, exactly as the product's own labeling allows
    • Subcutaneous injection, to slow systemic absorption and reduce reaction risk
    • Either intramuscular or subcutaneous, whichever site is easier to access on an actively moving patient
    • Intravenous or intraosseous administration only, even if the product labeling allows other routesCorrect

    Why: Regardless of what a specific product's own labeling states, the guideline directs that antivenom be given only by the intravenous route, with intraosseous access as an acceptable emergency alternative. Intramuscular or subcutaneous injection is not to be used even when the label appears to permit it, because these routes are less reliable and slower for a fast-acting, weight-independent antitoxin. IV is preferred but IO works when IV access cannot be obtained quickly.