Free NREMT EMT practice questions with answers

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

1. Question 1

   A patient presents with signs of shock and severe abdominal pain radiating to the back. On a brief visual inspection, the EMT does not see or feel a pulsating abdominal mass. What should the EMT conclude?

   • The absence of a palpable or visible pulsating mass does not rule out an abdominal aortic aneurysm, since this sign is uncommon and often hard to detectCorrect
   • A pulsating mass is always present with an AAA, so its absence rules out this diagnosis
   • The patient should be vigorously palpated to search further for a pulsating mass
   • This presentation can only be caused by a cardiac source of shock, not an AAA

   Why: The textbook notes that a pulsating mass may be felt in the abdomen with an AAA, but this is a rare sign that is often hard to detect, so the EMT should not conclude that an AAA is unlikely just because no mass is seen or felt on a brief inspection. Searching harder with vigorous palpation would be inappropriate and dangerous given the fragility of a leaking aneurysm, and this presentation is not exclusive to cardiac causes of shock; the pain pattern and shock together should keep AAA on the differential regardless of this one negative finding. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones and Bartlett Learning, 11th Edition), Gastrointestinal and Urologic Emergencies, pp. 708 to 712.

2. Question 2

   A burn patient develops a hoarse voice and audible stridor while en route to the hospital. What is the significance of these findings?

   • They are sentinel (warning) signs of a potentially significant airway burn that may progress rapidly to airway obstruction, warranting aggressive airway managementCorrect
   • They are expected, benign findings in any burn patient and require no specific action
   • They indicate the burn is confined to the skin and has not affected deeper structures
   • They most likely reflect anxiety rather than a true airway problem and can be safely monitored without intervention

   Why: Upper airway damage from an inhalation burn can cause rapid and serious airway compromise, with heat irritating the lungs and airway and causing swelling of the upper airway mucosa often evidenced by stridor; the EMT should consider requesting ALS backup when these signs appear, since airway swelling and compromise can develop quickly. Voice change and stridor are recognized as sentinel signs of a potentially significant airway burn that can rapidly lead to obstruction or respiratory failure, so they should never be dismissed as benign, attributed only to anxiety, or treated as evidence the injury is limited to the skin. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Soft-Tissue Injuries, p. 149.

3. Question 3

   An EMT locates a single gunshot entrance wound on a patient's abdomen. What additional step should the EMT take as part of the physical exam?

   • Inspect the patient's back and sides for a corresponding exit woundCorrect
   • Assume no exit wound exists unless the patient specifically reports feeling one
   • Avoid examining the back entirely to prevent disturbing a possible crime scene
   • Probe the entrance wound with a gloved finger to estimate how deep it travels

   Why: When an entry wound is found, the EMT must always check for a corresponding exit wound in the patient's back or sides, since a small entrance wound can sometimes be paired with a much larger exit wound depending on the object's velocity. Patients cannot reliably report the presence of an exit wound, examining the back for injuries is a necessary part of patient care even at a potential crime scene as long as evidence disturbance is minimized, and probing a wound to estimate depth is not an appropriate EMT technique and would not reliably indicate the wound's true extent. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Abdominal and Genitourinary Injuries, p. 378.

4. Question 4

   An EMS crew is the first unit to arrive at a residential structure fire with heavy smoke visible from the roofline, before fire apparatus arrives. If terrain and road layout allow it, where should the crew try to position their vehicle?

   • Downhill and downwind of the structure, to stay below the worst of the smoke
   • Uphill and/or upwind of the structure, since smoke is presentCorrect
   • Directly downwind, so the smoke plume shows exactly how the fire is spreading
   • Position does not matter until fire apparatus arrives on scene

   Why: General safe-parking guidance calls for positioning uphill and/or upwind of a scene whenever smoke or hazardous materials are present, and a working structure fire always produces smoke. Parking downhill or directly downwind puts the crew in the path of drifting smoke and its toxic byproducts, and waiting passively for fire apparatus to arrive before considering positioning ignores that scene safety begins with the first-arriving unit's own choices. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Transport Operations, pp. 1363-1366.

5. Question 5

   An EMT sees a diamond-shaped DOT placard on the side of a tanker truck involved in a highway crash. What kind of information does this placard actually convey?

   • The exact chemical name and its four-digit UN identification number
   • The broad hazard class of the material inside (such as flammable, poison, or corrosive), not the identity of the specific chemicalCorrect
   • The exact quantity of material being carried, down to the pound
   • The manufacturer and shipping company responsible for the load

   Why: A DOT placard is a general warning device, not a chemical-specific label. It identifies the broad hazard class the material belongs to, such as flammable, poison, or corrosive, so an EMT can quickly judge the general danger from a safe distance. Choice A overstates what a placard shows; the exact chemical and its UN number require closer, safer identification methods such as shipping papers or the Emergency Response Guidebook. Choice C is wrong because placards do not display cargo weight. Choice D is wrong because placards identify hazard class, not company information. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Incident Management, p. 1431.

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7. Question 6

   An EMT learns from dispatch that a patient has flu-like symptoms during flu season and initially assumes this is the likely cause. What concept from the primary EMT textbook warns against becoming so focused on this single explanation that other findings, such as a malfunctioning home heater, are overlooked?

   • Tunnel vision, in which becoming focused on one aspect of the patient's condition can cause the EMT to miss an important underlying problemCorrect
   • The Golden Period, which concerns the total time from injury to definitive surgical care
   • The GEMS diamond, a memory aid used specifically for geriatric patients
   • Cookbook medicine, which refers to strictly following equipment checklists before a shift

   Why: Tunnel vision occurs when an EMT becomes focused on one aspect of a patient's condition and excludes all others, which may cause the EMT to miss an important injury or illness, such as carbon monoxide poisoning masquerading as a household flu outbreak. The Golden Period and GEMS diamond are unrelated concepts used for different purposes, and cookbook medicine refers to rigidly following assessment steps by rote rather than equipment checklists. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Patient Assessment, pp. 340-346.

8. Question 7

   EMTs arrive to find an unrestrained driver who was ejected during a single-vehicle rollover crash. The patient is now standing beside the vehicle, talking normally, and denies any pain. Based on the mechanism of injury alone, what should guide the EMT's decision about the scope of the physical exam?

   • Perform a full rapid exam of the entire body, because ejection from a vehicle is itself a significant mechanism of injury regardless of how the patient currently appearsCorrect
   • Perform only a focused exam of any area the patient points to, since the patient denies pain
   • Skip the physical exam and transport based on the patient's own report that nothing hurts
   • Delay any exam until the patient develops a specific complaint en route

   Why: Ejection and partial ejection from a vehicle are identified as significant mechanisms of injury, and a patient who has sustained a significant mechanism should be treated with a full rapid exam of the entire body rather than a brief, complaint-based look, even when the patient is currently ambulatory and denies pain. A calm, pain-free presentation immediately after ejection does not reliably rule out serious internal or spinal injury, so the exam scope should be driven by the mechanism, not the patient's self-report or appearance. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Trauma Overview, pp. 853-856, 865. Cross-reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Patient Assessment, p. 332.

9. Question 8

   A patient was shot once in the abdomen. He is alert, oriented, and speaking in full sentences, and his initial vital signs are unremarkable. Why should the EMT still perform a full rapid trauma exam of the entire body rather than a focused exam of the gunshot wound alone?

   • Gunshot wounds are classified as a significant mechanism of injury on their own, regardless of how stable the patient initially appearsCorrect
   • A focused exam is always sufficient once the specific wound has been located and visualized
   • A full-body exam is required only if the patient loses consciousness
   • Normal initial vital signs confirm that no other body region needs to be examined

   Why: Gunshot wounds and stabbings are given as examples of significant mechanisms of injury, distinct from nonsignificant mechanisms such as an isolated injury to one body part. A patient who is alert, talking, and has normal initial vital signs immediately after being shot can still be compensating for serious internal injury, so the significant mechanism itself — not the patient's current presentation — is what calls for a full rapid exam of the entire body rather than a focused look at the entry wound alone. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Trauma Overview, pp. 850-861, 865. Cross-reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Patient Assessment, pp. 335-336.

10. Question 9

    For a plaintiff to prevail in a negligence lawsuit against an EMT, which combination of elements must generally all be proven?

    • Duty, breach of duty, causation, and damagesCorrect
    • Only that the EMT made some error, regardless of whether harm resulted
    • Only that the patient was unhappy with the outcome of care
    • Intent to harm the patient, since negligence always requires proof of intentional wrongdoing

    Why: Negligence is established only when all four elements are present: duty (the EMT had an obligation to provide care consistent with the standard of care), breach of duty (the EMT failed to meet that standard), causation (a reasonable cause-and-effect link between the breach and the harm), and damages (the patient was actually harmed physically or psychologically). Proving an error occurred without resulting harm is not enough on its own, patient dissatisfaction alone does not establish any of the four elements, and unlike an intentional tort, negligence does not require proof that the EMT meant to cause harm. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Medical, Legal, and Ethical Issues, p. 98.

11. Question 10

    A trauma patient is anxious, tachycardic, and has a radial pulse described as rapid and weak. This pulse quality is most consistent with which condition?

    • Normal perfusion under mild stress
    • Compensated shockCorrect
    • Decompensated shock
    • Neurogenic shock

    Why: A rapid, weak (thready) pulse together with anxiety and tachycardia are classic early signs of compensated shock, in which the sympathetic nervous system increases heart rate and constricts peripheral vessels to maintain blood pressure. Decompensated shock is a later stage marked by a falling systolic blood pressure and often absent peripheral pulses, which is not described here. Neurogenic shock typically presents with warm, dry skin and a normal or slow heart rate rather than tachycardia, and this presentation is not consistent with normal perfusion. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Shock, p. 497.

12. Question 11

    An EMT arrives at a warehouse incident and sees a diamond-shaped placard on a damaged storage container but cannot read the numbers on it from a safe distance. What resource is specifically designed to help identify the material and determine safe initial procedures once the identifying information can be read?

    • The patient's own account of what the container held
    • The US Department of Transportation Emergency Response Guidebook, which lists common hazardous materials and proper procedures for scene control and patient careCorrect
    • A generic internet search performed from a personal phone
    • The vehicle's registration paperwork

    Why: Hazardous materials incidents call for a specific, standardized reference rather than improvisation. The US Department of Transportation Emergency Response Guidebook is an important resource at a hazardous materials incident: it lists common hazardous materials and the proper procedures for scene control and the emergency care of patients, and a copy should be available in the unit or at dispatch, with the guidebook also downloadable from the US DOT's Pipeline and Hazardous Materials Safety Administration website. A patient's account may be unreliable or unavailable and is not a substitute for a standardized reference. A generic internet search is not the recognized, vetted resource for this purpose and could return inaccurate guidance. Vehicle registration paperwork identifies the vehicle, not the specific hazardous cargo or the safe-handling procedures needed. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Workforce Safety and Wellness, pp. 52-58. Cross-reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Patient Assessment, PDF p. 10.

13. Question 12

    A patient with a history of alcohol use reports severe pain in both the right and left upper quadrants of the abdomen that radiates to the back and is worse after eating. Which organ's inflammation is most consistent with this presentation?

    • Appendix
    • Urinary bladder
    • PancreasCorrect
    • Gallbladder alone

    Why: Pancreatitis can cause severe pain that presents in both the right and left upper quadrants and often radiates to the back, with the pain typically worse after eating; alcohol abuse and gallstones are among its common causes. Appendicitis instead produces right lower quadrant pain, the urinary bladder does not typically cause pain in the upper abdomen, and gallbladder disease alone would be expected to localize more to the right upper quadrant rather than both upper quadrants. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Gastrointestinal and Urologic Emergencies, p. 709.

14. Question 13

    A patient reportedly "seized" at school. Witnesses describe her suddenly staring blankly for about 10 seconds, not responding when spoken to, with no falling, no body shaking, and no confusion afterward; she returned to her normal activity immediately. What type of seizure does this most likely represent?

    • Absence (petit mal) seizureCorrect
    • Generalized tonic-clonic seizure
    • Complex partial seizure
    • Status epilepticus

    Why: The textbook describes a seizure that is simply a brief lapse of consciousness in which the patient stares and does not respond, without any change in motor activity, as a petit mal or absence seizure, lasting only seconds and followed by full recovery with only a brief memory lapse. This does not match the whole-body convulsions and lengthy postictal state of a generalized tonic-clonic seizure, the altered-interaction/automatisms of a complex partial seizure, or the recurrent/prolonged pattern of status epilepticus. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Neurologic Emergencies, pp. 682–684.

15. Question 14

    A pregnant patient reports abdominal pain unrelated to labor and has no signs suggesting imminent delivery. How should the EMT handle assessment of the perineal area?

    • Visually inspect the vaginal area as a routine part of every pregnant patient's secondary assessment
    • Do not visually inspect or touch the vaginal area unless there is reason to suspect imminent deliveryCorrect
    • Perform a full vaginal exam to rule out an abnormal fetal presentation
    • Ask a family member to inspect the area and report back to the EMT

    Why: If an EMT does not suspect an imminent delivery and the patient reports problems unrelated to delivery, the vaginal area should not be visually inspected, and in general the EMT should touch the vaginal area only during delivery itself and only once it has been determined that delivery is imminent. Routine inspection regardless of indication, performing an internal exam, or delegating the inspection to a family member are not consistent with protecting the patient's privacy and following this rule. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Obstetrics and Neonatal Care, p. 1195.

16. Question 15

    An ambulance operating in emergency mode approaches a school bus that is stopped, has its stop arm extended, and is loading children. What must the driver do?

    • Stop before reaching the bus, turn off the siren, and wait until the bus driver confirms the children are safe and the bus's warning lights are off before cautiously proceedingCorrect
    • Proceed past the bus at reduced speed with lights and siren still active, since emergency vehicles are exempt from school bus stop laws
    • Sound the horn repeatedly so the bus driver closes the doors immediately and lets the ambulance pass
    • Use the public address system to instruct the children to move aside so the ambulance can pass

    Why: Emergency vehicles are not given special privileges around a stopped school bus that is loading or unloading children and displaying its red warning lights and extended stop arm; the operator must obey the law like any other motorist. This means stopping before reaching the bus, turning off the siren, and waiting for the bus driver to confirm the children are safe, the door is closed, and the red lights are off before cautiously proceeding. Neither the horn nor the ambulance's PA system substitutes for this stop-and-wait requirement, and there is no lights-and-siren exemption for this situation. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Transport Operations, pp. 1374–1376.

17. Question 16

    For how long should you suction the airway of an adult patient during a single attempt?

    • No more than 15 secondsCorrect
    • No more than 60 seconds
    • Exactly 5 seconds
    • There is no time limit for adults

    Why: Suctioning removes air and oxygen from the airway along with the target secretions, so adult suction attempts are capped at 15 seconds, compared with 10 seconds for children and 5 seconds for infants, to avoid worsening hypoxia. Sixty seconds is far too long and would meaningfully desaturate the patient, 5 seconds is the infant limit rather than the adult one, and leaving suction time unlimited ignores the real risk of inducing hypoxia during the procedure. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Chapter 10, Airway Management, p. 410.

18. Question 17

    A patient has moderate bleeding from a forearm laceration. What is the correct first step in controlling this external bleeding?

    • Immediately apply a tourniquet proximal to the wound
    • Apply direct, even pressure to the bleeding siteCorrect
    • Elevate the extremity above the heart and wait for spontaneous clotting
    • Apply a hemostatic dressing before assessing the wound

    Why: Direct, local pressure applied over the bleeding site is the most effective first method for controlling external bleeding in most cases, stopping blood flow long enough to allow normal coagulation to occur. A tourniquet or hemostatic dressing is reserved for bleeding that direct pressure and a pressure dressing fail to control, and elevation of an extremity is no longer recommended because there is no evidence it helps control bleeding and it may aggravate other injuries. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Bleeding, p. 888.

19. Question 18

    Per the National Model EMS Clinical Guidelines' bradycardia guideline, when dosing medications for a pediatric patient who is obese, the dose should be based on which of the following?

    • The patient's ideal body weightCorrect
    • The patient's actual measured body weight
    • A fixed adult dose regardless of the patient's weight
    • The average weight for the patient's age group

    Why: The National Model EMS Clinical Guidelines' bradycardia guideline states that when dosing medications for pediatric patients, dosing should be weight-based for non-obese patients but based on ideal body weight for obese patients. Actual measured weight, a fixed adult dose, and an age-group average are not the dosing basis given for obese pediatric patients. Primary reference: National Model EMS Clinical Guidelines (NASEMSO, Version 3.0, March 2022), Bradycardia, p. 37.

20. Question 19

    A patient who overdosed on a tricyclic antidepressant and a patient who overdosed on a stimulant such as cocaine can present very similarly to an EMT in the field. What do these two toxidromes have in common that makes them hard to distinguish, according to the textbook?

    • Both groups of patients may be agitated and have tachycardia and dilated pupilsCorrect
    • Both always present with pinpoint pupils and a slow heart rate
    • Both are caused exclusively by prescription heart medications
    • Neither toxidrome ever causes agitation

    Why: The textbook states that it is often difficult to distinguish between an anticholinergic overdose and a sympathomimetic overdose because both groups of patients may be agitated and have tachycardia and dilated pupils. This is the opposite of describing either toxidrome as producing pinpoint pupils and bradycardia, and neither toxidrome is limited to prescription heart medications; sympathomimetics include stimulants such as cocaine and methamphetamine. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Toxicology, p. 307.

21. Question 20

    A conscious patient's pulse oximeter reads 91% on room air. What does this value indicate?

    • Mild to moderate hypoxemiaCorrect
    • Normal oxygenation
    • Severe, life-threatening hypoxemia
    • A falsely low reading that should be ignored

    Why: Pulse oximetry values of 95% to 100% are considered normal, while a reading between 90% and 94% indicates mild to moderate hypoxemia, which is exactly where 91% falls. It is not a normal value, it does not yet meet the threshold most sources use for severe hypoxemia (below 90%), and dismissing an abnormal reading outright ignores an important early warning sign rather than prompting further assessment. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Chapter 10, Airway Management, p. 404. Cross-reference: National Model EMS Clinical Guidelines, NASEMSO Version 3.0, PDF p. 179.

22. Question 21

    A single EMT is performing CPR on an adult without an advanced airway in place. What compression-to-ventilation ratio should be used?

    • 15 compressions to 2 ventilations
    • 30 compressions to 2 ventilationsCorrect
    • 5 compressions to 1 ventilation
    • Continuous compressions with no ventilations

    Why: A lone rescuer performing adult CPR provides a continuous cycle of 30 chest compressions followed by 2 ventilations (a 30:2 ratio), each set of 30 compressions taking about 17 seconds at the recommended rate. A 15:2 ratio is used for two-rescuer pediatric CPR, not single-rescuer adult CPR, a 5:1 ratio is not a standard adult BLS ratio, and continuous compressions without any ventilations is only used once an advanced airway is in place, not with basic airway management. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), BLS Resuscitation, p. 526.

23. Question 22

    An EMT wears gloves for an entire patient contact and never touches the patient with bare hands. Is handwashing still necessary before and after this contact?

    • No, gloves make handwashing unnecessary
    • Yes, hands should be washed before and after contact even when gloves were wornCorrect
    • Only if the gloves tore during the call
    • Only after contact, never before

    Why: Hands should always be washed before and after contact with a patient, even if gloves were worn throughout, because proper handwashing is the simplest yet most effective way to control disease transmission and gloves are not a perfect barrier. Small breaks in the skin such as tiny cuts and abrasions are potential entry points for pathogens, and the longer any organisms remain on the hands the greater the chance they get through those breaks. If running water is not available, a waterless hand sanitizer can be used temporarily, but soap-and-water handwashing should still be performed as soon as it is available, such as on arrival at the hospital. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Workforce Safety and Wellness, pp. 43-44.

24. Question 23

    In an adult patient with early hypovolemic shock from internal bleeding, which finding typically appears first, before any measurable change in blood pressure?

    • Hypotension
    • A change in mental status such as restlessness or anxietyCorrect
    • Absent peripheral pulses
    • Cyanosis of the lips

    Why: The first sign of hypovolemic shock is typically a change in mental status, such as anxiety, restlessness, or combativeness, caused by decreased oxygen delivery to the brain and increased sympathetic drive. Blood pressure is one of the last vital signs to change because compensatory mechanisms maintain it until significant blood loss has occurred, so hypotension and absent peripheral pulses are later, decompensated findings. Cyanosis of the lips is also a late finding rather than an early one. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Bleeding, p. 886.

25. Question 24

    According to the text, what are the two important underlying principles of the NIMS?

    • Flexibility and standardizationCorrect
    • Speed and secrecy
    • Centralization and cost control
    • Volunteerism and independence

    Why: The text names flexibility and standardization as the two important underlying principles of NIMS: the organizational structure must be flexible enough to adapt rapidly to any situation, while NIMS also provides standardization in terminology, resource classification, personnel training, and certification. Speed, secrecy, centralization, cost control, volunteerism, and independence are not the principles the text attributes to NIMS. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Incident Management, pp. 1411-1412.

26. Question 25

    During the primary assessment, an EMT needs to quickly classify a patient's gross level of consciousness. Which three categories does the EMT choose among at this stage?

    • Unconscious, conscious with an altered LOC, and conscious with an unaltered LOCCorrect
    • Alert and oriented x4, alert and oriented x3, and alert and oriented x2
    • Stable, potentially unstable, and unstable
    • Normal, mildly confused, and comatose

    Why: During the primary assessment the EMT only needs to determine the patient's gross level of consciousness by sorting the patient into one of three categories: unconscious, conscious with an altered LOC, or conscious with an unaltered LOC. Orientation scoring (alert and oriented x4, x3, and so on) is a more detailed follow-up step for a patient who is alert or responsive to voice, and stable/unstable is a separate judgment about overall condition, not a level-of-consciousness category. Primary reference: Emergency Care and Transportation of the Sick and Injured (AAOS/Jones & Bartlett Learning, 11th Edition), Patient Assessment, p. 324-325.