Working with acute hospital services: DipIMC practice questions

PHEM curriculum unit 1.8 · Theme 1: Working in Emergency Medical Systems

The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit 1.8, Work effectively with acute hospital services.

Below are 2 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 12 questions on this unit.

Question 1 · Law, Ethics & Human Factors · Moderate

You are 12 minutes from a major trauma centre with an intubated trauma patient and are about to pre-alert. Which best describes what NICE NG39 expects of a pre-alert?

AA brief warning that a trauma call is inbound, with the clinical detail given on arrival
BA structured dataset passed via switchboard for relay to the resuscitation room nurse
CA structured dataset sent only once the patient meets local trauma team activation criteria
DA structured dataset that then replaces a separate handover on arrival in the department
EA structured dataset with arrival time, received by a senior nurse or trauma team leader

Show answer

Answer: E

A structured dataset with arrival time, received by a senior nurse or trauma team leader

NICE NG39 asks for pre-alert information to be recorded using a structured system that includes the patient's age and sex, time of incident, mechanism of injury, injuries suspected, signs including vital signs and GCS, treatment so far, the estimated time of arrival at the emergency department, special requirements, the ambulance call sign, the name of the person taking the call and the time of call. A senior nurse or trauma team leader in the emergency department should receive the pre-alert and determine the level of trauma team response according to agreed local guidelines, so relaying it through switchboard, or waiting until activation criteria are met, defeats its purpose. A bare warning lets the receiving team prepare nothing. Handover in the department is a separate step: NG39 asks for a structured handover process that is documented, and NICE NG41 adds that the trauma team leader should be easily identifiable to receive the handover. The pre-alert does not replace it.

Where this comes from

NICE NG39 Major trauma: assessment and initial managementNICE, February 2016·Documentation, pre-alert and handover: pre-alert dataset“Record pre-alert information using a structured system and include all of the following”Open at this sentence
NICE NG39 Major trauma: assessment and initial managementNICE, February 2016·Documentation, pre-alert and handover: who receives the pre-alert“should receive the pre-alert information and determine the level of trauma team response”Open at this sentence
NICE NG39 Major trauma: assessment and initial managementNICE, February 2016·Documentation, pre-alert and handover: structured handover“Follow a structured process when handing over care within the emergency department”Open at this sentence
NICE NG39 Major trauma: assessment and initial managementNICE, February 2016·Documentation, pre-alert and handover: structured handover“Ensure that the handover is documented.”Open at this sentence
NICE NG41 Spinal injury: assessment and initial managementNICE, February 2016·Pre-alert and handover: trauma team leader“The trauma team leader should be easily identifiable to receive the handover”Open at this sentence

law-052 · Law, Ethics & Human Factors · EMS Systems · Moderate · v3

Question 2 · Law, Ethics & Human Factors · Moderate

A 40-year-old has fallen from a roof onto his back. He has weakness of both legs and altered sensation in both hands. His airway is clear and he is breathing adequately. The nearest trauma unit is 10 minutes away and the major trauma centre is 55 minutes away. What does NICE NG41 direct?

ANearest trauma unit whenever the major trauma centre is more than 30 minutes away by road
BMajor trauma centre with full in-line immobilisation, irrespective of the transfer time
CSpinal cord injury centre directly from scene, with full in-line spinal immobilisation
DNearest trauma unit with full in-line immobilisation, for imaging and secondary transfer
EMajor trauma centre only if the journey is 45 minutes or less, otherwise the trauma unit

Show answer

Answer: B

Major trauma centre with full in-line immobilisation, irrespective of the transfer time

Weakness in both legs and altered sensation in both hands after a fall means suspected acute traumatic spinal cord injury. NICE NG41 says such patients are transported with full in-line spinal immobilisation to a major trauma centre irrespective of transfer time. The exception is a patient who needs an immediate life-saving intervention the team cannot provide, who is diverted to the nearest trauma unit — not the case here, because his airway and breathing are adequate. NG41 contains no 30-minute or 45-minute cut-off. It says explicitly not to transport directly from the scene to a spinal cord injury centre. Taking him to the nearest trauma unit is the NG41 destination for an adult with suspected spinal column injury without suspected cord injury, which does not fit these neurological findings. The time threshold that candidates often confuse with this is in NG39: after failed or unachievable pre-hospital rapid sequence induction (RSI), go to a major trauma centre if the journey is 60 minutes or less.

Where this comes from

NICE NG41 Spinal injury: assessment and initial managementNICE·Destination: suspected spinal cord injury“to a major trauma centre irrespective of transfer time”Open at this sentence
NICE NG41 Spinal injury: assessment and initial managementNICE·Destination: diversion for a life-saving intervention“needs an immediate life-saving intervention”Open at this sentence
NICE NG41 Spinal injury: assessment and initial managementNICE·Destination: not directly to a spinal cord injury centre“directly to a spinal cord injury centre from the scene”Open at this sentence
NICE NG41 Spinal injury: assessment and initial managementNICE·Destination: column injury without cord injury in adults“to the nearest trauma unit, unless there are pre-hospital triage indications”Open at this sentence
NICE NG39 Major trauma: assessment and initial managementNICE·Airway management: RSI and the 60-minute journey“provided the journey time is 60 minutes or less”Open at this sentence

law-053 · Law, Ethics & Human Factors · EMS Systems · Moderate · v3

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Working with acute hospital services: DipIMC practice questions

More from Theme 1: Working in Emergency Medical Systems