NCOEMS PRACTICE EXAM 2025–2026
(NORTH CAROLINA OFFICE OF
EMERGENCY MEDICAL SERVICES) EXAM
300 ACTUAL QUESTIONS AND CORRECT
ANSWERS WITH RATIONALE LATEST
UPDATE
Section 1: EMS Systems, Operations, and Scene Safety (Questions 1–40)
Question 1
Under North Carolina OEMS administrative rules (10A NCAC 13B), which of the
following accurately describes the scope of practice for an EMT-Basic in North
Carolina?
A. EMT-Basics may administer any medication prescribed by a physician
B. EMT-Basics may perform endotracheal intubation under standing orders
C. EMT-Basics may assist patients with self-administered medications and
perform basic airway adjuncts such as OPA and NPA insertion
D. EMT-Basics may independently administer IV medications without medical
direction
Correct Answer: C
Rationale: Under NC OEMS rules, EMT-Basics are authorized to assist patients
with self-administered medications (such as patient-owned nitroglycerin or
epinephrine auto-injectors) and to insert basic airway adjuncts including
oropharyngeal and nasopharyngeal airways. They may not independently
administer IV medications or perform advanced procedures like intubation, which
require higher certification levels such as EMT-Intermediate or Paramedic.
Question 2
What is the primary difference between online medical direction and offline
medical direction in the North Carolina EMS system?
A. Online medical direction is provided by a base hospital physician via radio or
phone, while offline medical direction consists of pre-written standing orders and
protocols
,B. Online medical direction involves face-to-face physician consultations, while
offline medical direction uses telemedicine
C. Online medical direction is used only for trauma calls, while offline medical
direction is used for medical calls
D. There is no difference; both terms refer to the same process of physician
oversight
Correct Answer: A
Rationale: Online medical direction (also called direct medical direction) involves
real-time communication between the EMS provider and a base hospital physician
via radio or phone. Offline medical direction consists of pre-written standing
orders, protocols, and treatment guidelines that EMS providers follow without
direct real-time physician contact.
Question 3
A paramedic crew arrives first at a multi-vehicle collision on a highway with active
traffic. Several patients are visible, including one pinned inside a vehicle with
heavy structural damage. What is the most appropriate initial action to ensure
scene safety and operational control?
A. Immediately begin extrication of the trapped patient
B. Establish incident command and request additional resources
C. Perform rapid triage on all visible patients
D. Begin airway management on the most critically injured patient
Correct Answer: B
Rationale: In mass-casualty or multi-patient incidents, scene safety and system
control take priority. Establishing incident command ensures coordinated
operations, resource allocation, and hazard management. Immediate extrication or
treatment without scene control increases risk to rescuers and patients. Triage
follows structured command setup, not precedes it.
Question 4
During initial scene assessment of a residential structure fire with reported
casualties, which hazard presents the highest immediate risk to EMS personnel?
A. Possible carbon monoxide exposure
B. Broken glass and debris
C. Emotional family bystanders
D. Minor smoke irritation
Correct Answer: A
Rationale: Carbon monoxide is an invisible, rapidly lethal toxin in fire
environments. It can incapacitate providers before symptoms are recognized.
,Structural hazards like debris are secondary to atmospheric threats in enclosed fire
scenes.
Question 5
You are called to assist a 60-year-old female complaining of a severe headache.
Upon entering the home, you smell a strong odor of natural gas. What is your first
action?
A. Check the patient's airway, breathing, and circulation
B. Insert a nasopharyngeal airway and assess vital signs
C. Remove the patient from the house to your ambulance
D. Open all windows and determine the source of the gas leak
Correct Answer: C
Rationale: Scene safety is the absolute priority in any emergency situation. You
must remove the patient from the dangerous environment before providing care.
Your safety and the patient's safety come first. Natural gas leaks pose explosion
and inhalation risks.
Question 6
What is the first action you should take when arriving at the scene of an
unconscious patient?
A. Check the patient's pulse
B. Assess the environment for safety
C. Administer oxygen
D. Begin CPR
Correct Answer: B
Rationale: According to NCOEMS guidelines, the first step in any patient
encounter is to ensure scene safety. You cannot help a patient if you become a
victim yourself.
Question 7
EMTs should wear high-efficiency particulate air (HEPA) respirators when they
are in contact with patients who have which of the following?
A. HIV or AIDS
B. Tuberculosis (TB)
C. Open wounds
D. Hepatitis B
Correct Answer: B
Rationale: Tuberculosis is transmitted via airborne droplets and requires HEPA
(N95) respirators for protection. HIV, Hepatitis B, and open wounds require
, standard precautions and possibly eye protection, but not HEPA respirators unless
aerosol-generating procedures are performed.
Question 8
You are approached by a journalist and asked whether you transported Jane Doe to
the emergency department. You should:
A. Give the journalist any information he needs
B. Confirm that you did transport the patient, but provide no further details
C. Refuse to provide any information about the patient
D. Only provide information if the patient gives consent
Correct Answer: C
Rationale: Patient confidentiality is protected under HIPAA and North Carolina
law. EMS providers must not confirm or deny any patient information to the media
or any unauthorized individuals. Only provide information with patient consent or
as required by law.
Question 9
In which situation should you call for immediate assistance?
A. You must care for two critical patients with gunshot wounds
B. Your patient is a 26-year-old female in active labor
C. Your patient is a child with fever who has had a brief seizure
D. Your partner is needed to stabilize the cervical spine
Correct Answer: A
Rationale: Two critical patients with gunshot wounds require additional resources
and personnel. Multiple critical patients exceed the capacity of a single EMS crew
and require immediate additional assistance.
Question 10
A non-trauma patient was pulseless and apneic. Assisted ventilation was attempted
but unsuccessful. After repositioning the head, a repeat ventilation is still
unsuccessful. What is the next most appropriate step?
A. Check for an airway obstruction
B. Continue chest compressions only
C. Attempt ventilations using an alternative method
D. Continue repositioning the head
Correct Answer: A
Rationale: When ventilation attempts are unsuccessful despite repositioning, the
next step is to check for an airway obstruction. This may include visualizing the
oropharynx and using suction or forceps to remove any visible obstruction.
(NORTH CAROLINA OFFICE OF
EMERGENCY MEDICAL SERVICES) EXAM
300 ACTUAL QUESTIONS AND CORRECT
ANSWERS WITH RATIONALE LATEST
UPDATE
Section 1: EMS Systems, Operations, and Scene Safety (Questions 1–40)
Question 1
Under North Carolina OEMS administrative rules (10A NCAC 13B), which of the
following accurately describes the scope of practice for an EMT-Basic in North
Carolina?
A. EMT-Basics may administer any medication prescribed by a physician
B. EMT-Basics may perform endotracheal intubation under standing orders
C. EMT-Basics may assist patients with self-administered medications and
perform basic airway adjuncts such as OPA and NPA insertion
D. EMT-Basics may independently administer IV medications without medical
direction
Correct Answer: C
Rationale: Under NC OEMS rules, EMT-Basics are authorized to assist patients
with self-administered medications (such as patient-owned nitroglycerin or
epinephrine auto-injectors) and to insert basic airway adjuncts including
oropharyngeal and nasopharyngeal airways. They may not independently
administer IV medications or perform advanced procedures like intubation, which
require higher certification levels such as EMT-Intermediate or Paramedic.
Question 2
What is the primary difference between online medical direction and offline
medical direction in the North Carolina EMS system?
A. Online medical direction is provided by a base hospital physician via radio or
phone, while offline medical direction consists of pre-written standing orders and
protocols
,B. Online medical direction involves face-to-face physician consultations, while
offline medical direction uses telemedicine
C. Online medical direction is used only for trauma calls, while offline medical
direction is used for medical calls
D. There is no difference; both terms refer to the same process of physician
oversight
Correct Answer: A
Rationale: Online medical direction (also called direct medical direction) involves
real-time communication between the EMS provider and a base hospital physician
via radio or phone. Offline medical direction consists of pre-written standing
orders, protocols, and treatment guidelines that EMS providers follow without
direct real-time physician contact.
Question 3
A paramedic crew arrives first at a multi-vehicle collision on a highway with active
traffic. Several patients are visible, including one pinned inside a vehicle with
heavy structural damage. What is the most appropriate initial action to ensure
scene safety and operational control?
A. Immediately begin extrication of the trapped patient
B. Establish incident command and request additional resources
C. Perform rapid triage on all visible patients
D. Begin airway management on the most critically injured patient
Correct Answer: B
Rationale: In mass-casualty or multi-patient incidents, scene safety and system
control take priority. Establishing incident command ensures coordinated
operations, resource allocation, and hazard management. Immediate extrication or
treatment without scene control increases risk to rescuers and patients. Triage
follows structured command setup, not precedes it.
Question 4
During initial scene assessment of a residential structure fire with reported
casualties, which hazard presents the highest immediate risk to EMS personnel?
A. Possible carbon monoxide exposure
B. Broken glass and debris
C. Emotional family bystanders
D. Minor smoke irritation
Correct Answer: A
Rationale: Carbon monoxide is an invisible, rapidly lethal toxin in fire
environments. It can incapacitate providers before symptoms are recognized.
,Structural hazards like debris are secondary to atmospheric threats in enclosed fire
scenes.
Question 5
You are called to assist a 60-year-old female complaining of a severe headache.
Upon entering the home, you smell a strong odor of natural gas. What is your first
action?
A. Check the patient's airway, breathing, and circulation
B. Insert a nasopharyngeal airway and assess vital signs
C. Remove the patient from the house to your ambulance
D. Open all windows and determine the source of the gas leak
Correct Answer: C
Rationale: Scene safety is the absolute priority in any emergency situation. You
must remove the patient from the dangerous environment before providing care.
Your safety and the patient's safety come first. Natural gas leaks pose explosion
and inhalation risks.
Question 6
What is the first action you should take when arriving at the scene of an
unconscious patient?
A. Check the patient's pulse
B. Assess the environment for safety
C. Administer oxygen
D. Begin CPR
Correct Answer: B
Rationale: According to NCOEMS guidelines, the first step in any patient
encounter is to ensure scene safety. You cannot help a patient if you become a
victim yourself.
Question 7
EMTs should wear high-efficiency particulate air (HEPA) respirators when they
are in contact with patients who have which of the following?
A. HIV or AIDS
B. Tuberculosis (TB)
C. Open wounds
D. Hepatitis B
Correct Answer: B
Rationale: Tuberculosis is transmitted via airborne droplets and requires HEPA
(N95) respirators for protection. HIV, Hepatitis B, and open wounds require
, standard precautions and possibly eye protection, but not HEPA respirators unless
aerosol-generating procedures are performed.
Question 8
You are approached by a journalist and asked whether you transported Jane Doe to
the emergency department. You should:
A. Give the journalist any information he needs
B. Confirm that you did transport the patient, but provide no further details
C. Refuse to provide any information about the patient
D. Only provide information if the patient gives consent
Correct Answer: C
Rationale: Patient confidentiality is protected under HIPAA and North Carolina
law. EMS providers must not confirm or deny any patient information to the media
or any unauthorized individuals. Only provide information with patient consent or
as required by law.
Question 9
In which situation should you call for immediate assistance?
A. You must care for two critical patients with gunshot wounds
B. Your patient is a 26-year-old female in active labor
C. Your patient is a child with fever who has had a brief seizure
D. Your partner is needed to stabilize the cervical spine
Correct Answer: A
Rationale: Two critical patients with gunshot wounds require additional resources
and personnel. Multiple critical patients exceed the capacity of a single EMS crew
and require immediate additional assistance.
Question 10
A non-trauma patient was pulseless and apneic. Assisted ventilation was attempted
but unsuccessful. After repositioning the head, a repeat ventilation is still
unsuccessful. What is the next most appropriate step?
A. Check for an airway obstruction
B. Continue chest compressions only
C. Attempt ventilations using an alternative method
D. Continue repositioning the head
Correct Answer: A
Rationale: When ventilation attempts are unsuccessful despite repositioning, the
next step is to check for an airway obstruction. This may include visualizing the
oropharynx and using suction or forceps to remove any visible obstruction.
