Serious traumatic injuries in the workplace — head and spinal trauma, fractures, crush injuries, and penetrating wounds — require first aid decisions that are more nuanced than minor wound care. The wrong action, such as moving a worker with a suspected spinal injury, can convert a survivable injury into permanent disability. The right action, performed correctly and in sequence, can maintain function until EMS arrives.
This practice test covers recognition, first aid response, and decision-making for serious traumatic injuries most likely to occur in construction, manufacturing, and general industry environments. Questions range from beginner to advanced and include scenario-based learning.
Introduction
The 2024 BLS data shows 5,070 fatal work injuries in the US and approximately 2.5 million nonfatal injuries requiring medical treatment beyond first aid. Among serious traumatic injuries, the decisions made in the first minutes determine outcomes that no amount of downstream medical care can reverse.
This practice test is designed for designated first aid responders, safety supervisors, and any worker in a high-hazard environment. Formal first aid certification requires hands-on training with a qualified provider. These questions test knowledge of recognition, response sequencing, and common errors. Every answer includes an explanation of why the correct answer is right and why the alternatives are wrong.
Head and Spinal Injuries
Question 1 | Beginner
A worker falls from a ladder and lands on a concrete floor. He is conscious and saying his neck hurts. What is the most important first aid action?
- A) Help him sit up so he is more comfortable
- B) Give him water to drink since he is conscious
- C) Tell him to hold still; prevent him from moving his head and neck while calling 911
- D) Check if anything is broken in his arms and legs before worrying about his neck
Question 2 | Intermediate
A construction worker is found unconscious at the base of scaffolding. He has no visible wounds on his head. You notice blood and clear fluid coming from his left ear. What does this sign indicate and what should you do?
- A) The ear is bleeding from a minor wound; clean it with the first aid kit
- B) This is a sign of possible skull base fracture; call 911, do not pack or block the ear, apply spinal precautions
- C) He probably has a ruptured eardrum from noise exposure; this is not an emergency
- D) Apply direct pressure to the ear with a sterile gauze pad to stop the bleeding
Question 3 | Advanced
A worker is unconscious and not breathing normally following a head-on vehicle collision on a construction site. You suspect a cervical spine injury based on the mechanism. What is the correct CPR airway management approach?
- A) Do not open the airway because of the spinal injury risk; wait for EMS
- B) Use the jaw-thrust technique to open the airway without tilting the head
- C) Use head-tilt, chin-lift as normal because CPR takes priority over spinal precautions
- D) Roll the worker onto their side before beginning airway management
Fractures and Dislocations
Question 4 | Beginner
A worker is hit in the forearm by a falling object and cannot move her arm. The skin is intact, and the forearm is visibly deformed and swollen. What should the first aider do?
- A) Gently try to straighten the arm to reduce the fracture before splinting
- B) Splint the arm in the position it is in; do not try to realign the bones
- C) Have the worker continue working and see if the pain improves over the shift
- D) Apply an ice pack directly to the skin over the deformed area
Question 5 | Intermediate
After immobilizing a suspected forearm fracture, what must the first aider check and why?
- A) Color, warmth, and sensation distal to the injury, to confirm blood flow and nerve function
- B) The worker’s temperature, to rule out infection
- C) Whether the worker can write with the injured arm, to confirm fracture severity
- D) The location of the nearest hospital, before doing anything else
Question 6 | Advanced
A worker is suspected of having a pelvic fracture following a forklift collision. She is conscious and in severe pain. What are the two most important first aid actions in order?
- A) Log-roll her to a more comfortable position, then call 911
- B) Call 911 immediately; do not move her unless the environment is unsafe
- C) Splint the pelvis with a board and elevate her legs above heart level
- D) Give her aspirin and water while waiting for EMS
Crush Injuries and Compartment Syndrome
Question 7 | Intermediate
A worker’s hand and forearm have been trapped under a heavy equipment component for approximately 20 minutes. EMS has been called. The component is being lifted off. What should you be prepared for and what is the first action when the limb is freed?
- A) Expect immediate improvement; apply a heating pad to restore circulation
- B) Be prepared for crush syndrome; do not apply a tourniquet; call to update EMS that the limb is now freed
- C) Elevate the limb immediately as high as possible to prevent swelling
- D) Do not touch the limb until EMS arrives
Penetrating Wounds
Question 8 | Beginner
A worker has a piece of metal rod embedded in his thigh. The rod is approximately 6 inches long and is protruding about 3 inches from the wound. What is the correct first aid action?
- A) Remove the rod and apply direct pressure to the wound
- B) Leave the rod in place, stabilize it so it cannot move, apply pressure around the wound, and call 911
- C) Push the rod further in to reduce the portion that is sticking out
- D) Apply a tourniquet above the wound regardless of bleeding severity
Question 9 | Advanced
A worker has a penetrating chest wound that is making a sucking sound with each breath. What does this indicate and what is the correct first aid response?
- A) This is normal after a chest impact; monitor and give water
- B) It indicates an open pneumothorax; seal the wound with an occlusive dressing on three sides
- C) It indicates a pneumothorax; do not touch the wound and call 911
- D) Apply tight circumferential bandaging around the entire chest to seal the wound
Scenario-Based Learning
Scenario 1: The Tower Crane Incident
A ironworker falls 15 feet from a tower crane and lands on a steel deck. He is conscious and appears disoriented. His hard hat is cracked. He tells you he cannot feel his legs. Co-workers want to move him to a safer location away from the crane.
Q1: Should the workers move him?
No, not without appropriate spinal immobilization. The loss of lower extremity sensation following a fall with a cracked helmet is highly suggestive of a spinal cord injury. Moving him without a proper log-roll technique and a rigid backboard risks converting an incomplete cord injury (some function preserved) into a complete cord injury (total loss of function below the injury level). The only exception is if the worker is in immediate, direct physical danger from the crane or environment. In that case, drag him straight back along his long axis, keeping head, neck, and spine in alignment as much as possible.
Q2: What is the correct sequence of actions?
Call 911 immediately and give the specific location. Assign one person to maintain the head and neck in the position found, preventing any movement. Keep other workers back to prevent further accidental movement. Keep the worker warm. Do not give food or water. Monitor for changes in consciousness and breathing. When asked about symptoms, note and report any numbness, tingling, pain, or weakness in any part of the body. When EMS arrives, report: the mechanism, the height of the fall, the presence of helmet damage, and the sensory findings.
Q3: What are the legal and regulatory implications?
This incident triggers OSHA mandatory reporting requirements: if the worker is hospitalized as an inpatient, the employer must report within 24 hours. If the injury results in death, report within 8 hours. The incident must be investigated under 29 CFR 1904 requirements. Fall protection deficiencies (if any) may result in citations under 29 CFR 1926.501.
Scenario 2: The Warehouse Crushing
A warehouse worker is pinned between a moving pallet jack and a fixed rack for approximately 45 minutes before a co-worker finds him and is able to release the equipment. He has a suspected rib fracture and significant bruising across the torso. He is conscious but confused.
Q1: What medical risk must EMS be warned about?
Crush syndrome (rhabdomyolysis) is the primary systemic risk after prolonged crush injury. Compressed muscle releases myoglobin and potassium into the bloodstream when compression is released. Elevated potassium can cause fatal cardiac arrhythmias. Myoglobin damages kidney tubules, causing acute kidney failure. EMS must be informed of the duration of crush and the mechanism so they can initiate IV fluids for rhabdomyolysis management before it is clinically apparent.
Q2: What should the first aider do while waiting for EMS?
Keep the worker still and warm. Monitor mental status continuously; confusion that worsens indicates deteriorating brain perfusion and is a sign of shock progression. Do not give food or water. Prepare to perform CPR if cardiac arrest occurs. Update EMS if the worker’s condition changes before their arrival.
Knowledge Check
What is the correct first aid action for a sucking chest wound before EMS arrives?
Sources
- AHA/Red Cross, “2024 First Aid Guidelines” (Circulation, 2024)
- BLS, “Census of Fatal Occupational Injuries 2024”
- OSHA, “29 CFR 1910.151: Medical Services and First Aid”
- OSHA, “29 CFR 1904.39: Reporting Fatalities, Hospitalizations, Amputations”
- NCBI StatPearls, “Crush Injuries and Rhabdomyolysis”
- OSHA, “29 CFR 1926.501: Duty to Have Fall Protection”