AIR EVAC EXAM STUDY GUIDE 2026 – COMPLETE
CONCEPT REVIEW & PRACTICE MATERIALS (LATEST
EDITION)
Section 1: Aviation & Aeronautical Decision Making (25 Questions)
1. What is the primary purpose of a Risk Assessment Matrix (RAM) in air medical operations?
A: To objectively evaluate the potential risks (likelihood vs. severity) of a mission before launch
and to support a safe Go/No-Go decision.
2. What does the acronym "IMSAFE" stand for in pilot/crew self-assessment?
A: Illness, Medication, Stress, Alcohol, Fatigue, Emotion/Eating.
3. During pre-flight, what does the term "NOTAMs" refer to?
A: Notices to Airmen – critical information on potential hazards or changes to the navigational
environment (e.g., closed runways, cranes, temporary obstacles).
4. What is the most critical phase of flight for helicopter EMS (HEMS) accidents?
A: Approach and landing, often at uncontrolled or unprepared landing zones (LZs).
5. What does the term "autorotation" mean?
A: A procedure where the helicopter's rotor blades are driven by upward airflow in the event of
engine failure, allowing for a controlled, powered-descent landing.
6. Define "height-velocity diagram" (or "dead man's curve").
A: A chart that defines combinations of altitude and airspeed where a successful autorotation
may not be possible if an engine failure occurs.
7. What is the significance of "density altitude"?
A: It is pressure altitude corrected for non-standard temperature. High density altitude
(hot/humid/high elevation) reduces engine and rotor performance, requiring longer takeoff
distances and reducing climb rates.
8. In crew resource management (CRM), what is the principle of "assertiveness"?
A: The obligation of any crew member to speak up clearly if they perceive a safety issue,
regardless of rank or role.
9. What is a "confined area" landing?
A: A landing zone where obstacles (trees, wires, buildings) significantly limit approach and
departure paths, requiring specialized techniques.
,10. What is the purpose of a "hover check" prior to landing at an unfamiliar LZ?
A: To assess ground conditions (dust, debris, slope), verify obstacle clearance, and check for
wires or hazards before committing to a full touchdown.
11. Who has final authority for the safe operation of the aircraft?
A: The Pilot in Command (PIC).
12. What is "spatial disorientation," and why is it a major risk for HEMS?
A: The inability to determine one's position, altitude, or motion relative to the Earth, especially
in IMC (instrument meteorological conditions) or at night over featureless terrain.
13. What should a crew member do if they become disoriented or nauseous during flight?
A: Focus on a fixed point inside the aircraft, close their eyes if necessary, and inform the pilot
and other crew.
14. What does "VFR" stand for, and what are its basic requirements?
A: Visual Flight Rules. Requires visibility and cloud clearance minima to navigate and avoid
terrain and obstacles by visual reference.
15. What is the primary cause of "wire strikes" in HEMS operations?
A: Failure to properly identify and avoid wires during approach/departure, often due to poor
visibility, clutter, or wire placement (e.g., on unmarked poles).
16. What does the acronym "PAVE" used in preflight risk assessment stand for?
A: Pilot, Aircraft, enVironment, External pressures.
17. What is a "flight following"?
A: A service where ground personnel monitor the aircraft's position and status via radar, GPS
tracking, or radio reports throughout the flight.
18. What is the primary role of the crew member regarding the aircraft door?
A: To ensure it is properly secured for takeoff and landing, and to manage its opening/closing
according to the pilot's command at the LZ.
19. What weather phenomenon is particularly dangerous for helicopters due to rapid changes
in lift?
A: Microbursts or severe wind shear.
20. Why is proper weight and balance critical for helicopter operations?
A: It affects the center of gravity, which is crucial for aircraft stability and control. An out-of-
balance helicopter can be unflyable.
21. What does "IFR" stand for?
A: Instrument Flight Rules (flying by reference to instruments, typically in poor weather).
,22. What is a "black hole" approach, and why is it dangerous?
A: An approach over water or unlit terrain on a dark night, with few ground lights, leading to a
loss of depth perception and potential controlled flight into terrain (CFIT).
23. When approaching the aircraft, what is the "safe approach" path?
A: Always approach/depart from the front and side, in view of the pilot, never from the rear
where the tail rotor is invisible and lethal.
24. What is the significance of the "decision point" in a risk management tool?
A: A pre-determined point (in time, fuel, or location) where a mission must be re-evaluated and
potentially aborted if conditions are not met.
25. What is the primary goal of AMRM?
A: To use all available resources (people, procedures, technology) to achieve safe and efficient
flight operations.
Section 2: Medical Knowledge & Patient Care (35 Questions)
26. What are the components of the primary survey in trauma assessment?
A: ABCDE: Airway (with c-spine), Breathing, Circulation, Disability (neuro),
Exposure/Environment.
27. What is the first intervention for a patient with a suspected tension pneumothorax?
A: Immediate needle decompression (thoracostomy) in the 2nd intercostal space, midclavicular
line.
28. What are signs of a tension pneumothorax?
A: Severe respiratory distress, tracheal deviation away from affected side, distended neck veins,
hypotension, unilateral absent breath sounds, hyperresonance to percussion.
29. What is the preferred route for medication administration in a crashing patient with no IV
access?
A: Intraosseous (IO) access.
30. What is the dose of epinephrine for adult cardiac arrest?
A: 1 mg (1:10,000 solution) every 3-5 minutes.
31. What is the management priority for a patient with a severe head injury and decreasing
LOC?
A: Secure airway (with RSI if needed), ensure adequate oxygenation and ventilation to avoid
hypercarbia, and maintain cerebral perfusion (avoid hypotension).
, 32. What is "Golden Hour" and "Platinum Ten Minutes"?
A: Golden Hour: The concept that definitive trauma care within the first hour of injury improves
survival. Platinum Ten: The goal to be on scene for no more than 10 minutes for a critical
trauma patient.
33. What is the treatment for symptomatic bradycardia?
A: Atropine 0.5 mg IV/IO (repeat up to 3 mg). If ineffective, transcutaneous pacing or
dopamine/epinephrine infusions.
34. Describe the signs of severe opioid overdose.
A: CNS depression (coma), respiratory depression (slow, shallow, or absent), pinpoint pupils,
bradycardia, hypotension.
35. What is the antidote for opioid overdose?
A: Naloxone (Narcan).
36. What is the initial fluid resuscitation for hemorrhagic shock in trauma?
A: Balanced blood products (1:1:1 ratio of RBCs:Plasma:Platelets) if available, or 1-2 L bolus of
warmed crystalloid (e.g., Lactated Ringer's), per permissive hypotension protocols if
appropriate.
37. What is "permissive hypotension"?
A: Allowing a lower-than-normal BP (e.g., SBP 80-90 mmHg) in trauma patients with
uncontrolled hemorrhage until surgical control is achieved, to avoid disrupting clots and
worsening bleeding.
38. What is a key sign of cardiac tamponade?
A: Beck's Triad: Hypotension, distended neck veins (JVD), muffled heart sounds. Also may see
pulsus paradoxus.
39. What is the priority treatment for a STEMI patient?
A: ASA, Nitroglycerin (if BP permits), Oxygen (if hypoxic), Morphine for pain, and rapid transport
to a PCI-capable facility. Monitor for and treat arrhythmias.
40. What are the signs of a severe asthma attack (status asthmaticus)?
A: Altered mental status, fatigue, silent chest (no wheeze due to minimal airflow), hypoxia,
hypercarbia, use of accessory muscles, pulsus paradoxus.
41. What is the first-line medication for anaphylaxis?
A: Intramuscular Epinephrine (0.3-0.5 mg of 1:1,000 in the mid-anterolateral thigh).
CONCEPT REVIEW & PRACTICE MATERIALS (LATEST
EDITION)
Section 1: Aviation & Aeronautical Decision Making (25 Questions)
1. What is the primary purpose of a Risk Assessment Matrix (RAM) in air medical operations?
A: To objectively evaluate the potential risks (likelihood vs. severity) of a mission before launch
and to support a safe Go/No-Go decision.
2. What does the acronym "IMSAFE" stand for in pilot/crew self-assessment?
A: Illness, Medication, Stress, Alcohol, Fatigue, Emotion/Eating.
3. During pre-flight, what does the term "NOTAMs" refer to?
A: Notices to Airmen – critical information on potential hazards or changes to the navigational
environment (e.g., closed runways, cranes, temporary obstacles).
4. What is the most critical phase of flight for helicopter EMS (HEMS) accidents?
A: Approach and landing, often at uncontrolled or unprepared landing zones (LZs).
5. What does the term "autorotation" mean?
A: A procedure where the helicopter's rotor blades are driven by upward airflow in the event of
engine failure, allowing for a controlled, powered-descent landing.
6. Define "height-velocity diagram" (or "dead man's curve").
A: A chart that defines combinations of altitude and airspeed where a successful autorotation
may not be possible if an engine failure occurs.
7. What is the significance of "density altitude"?
A: It is pressure altitude corrected for non-standard temperature. High density altitude
(hot/humid/high elevation) reduces engine and rotor performance, requiring longer takeoff
distances and reducing climb rates.
8. In crew resource management (CRM), what is the principle of "assertiveness"?
A: The obligation of any crew member to speak up clearly if they perceive a safety issue,
regardless of rank or role.
9. What is a "confined area" landing?
A: A landing zone where obstacles (trees, wires, buildings) significantly limit approach and
departure paths, requiring specialized techniques.
,10. What is the purpose of a "hover check" prior to landing at an unfamiliar LZ?
A: To assess ground conditions (dust, debris, slope), verify obstacle clearance, and check for
wires or hazards before committing to a full touchdown.
11. Who has final authority for the safe operation of the aircraft?
A: The Pilot in Command (PIC).
12. What is "spatial disorientation," and why is it a major risk for HEMS?
A: The inability to determine one's position, altitude, or motion relative to the Earth, especially
in IMC (instrument meteorological conditions) or at night over featureless terrain.
13. What should a crew member do if they become disoriented or nauseous during flight?
A: Focus on a fixed point inside the aircraft, close their eyes if necessary, and inform the pilot
and other crew.
14. What does "VFR" stand for, and what are its basic requirements?
A: Visual Flight Rules. Requires visibility and cloud clearance minima to navigate and avoid
terrain and obstacles by visual reference.
15. What is the primary cause of "wire strikes" in HEMS operations?
A: Failure to properly identify and avoid wires during approach/departure, often due to poor
visibility, clutter, or wire placement (e.g., on unmarked poles).
16. What does the acronym "PAVE" used in preflight risk assessment stand for?
A: Pilot, Aircraft, enVironment, External pressures.
17. What is a "flight following"?
A: A service where ground personnel monitor the aircraft's position and status via radar, GPS
tracking, or radio reports throughout the flight.
18. What is the primary role of the crew member regarding the aircraft door?
A: To ensure it is properly secured for takeoff and landing, and to manage its opening/closing
according to the pilot's command at the LZ.
19. What weather phenomenon is particularly dangerous for helicopters due to rapid changes
in lift?
A: Microbursts or severe wind shear.
20. Why is proper weight and balance critical for helicopter operations?
A: It affects the center of gravity, which is crucial for aircraft stability and control. An out-of-
balance helicopter can be unflyable.
21. What does "IFR" stand for?
A: Instrument Flight Rules (flying by reference to instruments, typically in poor weather).
,22. What is a "black hole" approach, and why is it dangerous?
A: An approach over water or unlit terrain on a dark night, with few ground lights, leading to a
loss of depth perception and potential controlled flight into terrain (CFIT).
23. When approaching the aircraft, what is the "safe approach" path?
A: Always approach/depart from the front and side, in view of the pilot, never from the rear
where the tail rotor is invisible and lethal.
24. What is the significance of the "decision point" in a risk management tool?
A: A pre-determined point (in time, fuel, or location) where a mission must be re-evaluated and
potentially aborted if conditions are not met.
25. What is the primary goal of AMRM?
A: To use all available resources (people, procedures, technology) to achieve safe and efficient
flight operations.
Section 2: Medical Knowledge & Patient Care (35 Questions)
26. What are the components of the primary survey in trauma assessment?
A: ABCDE: Airway (with c-spine), Breathing, Circulation, Disability (neuro),
Exposure/Environment.
27. What is the first intervention for a patient with a suspected tension pneumothorax?
A: Immediate needle decompression (thoracostomy) in the 2nd intercostal space, midclavicular
line.
28. What are signs of a tension pneumothorax?
A: Severe respiratory distress, tracheal deviation away from affected side, distended neck veins,
hypotension, unilateral absent breath sounds, hyperresonance to percussion.
29. What is the preferred route for medication administration in a crashing patient with no IV
access?
A: Intraosseous (IO) access.
30. What is the dose of epinephrine for adult cardiac arrest?
A: 1 mg (1:10,000 solution) every 3-5 minutes.
31. What is the management priority for a patient with a severe head injury and decreasing
LOC?
A: Secure airway (with RSI if needed), ensure adequate oxygenation and ventilation to avoid
hypercarbia, and maintain cerebral perfusion (avoid hypotension).
, 32. What is "Golden Hour" and "Platinum Ten Minutes"?
A: Golden Hour: The concept that definitive trauma care within the first hour of injury improves
survival. Platinum Ten: The goal to be on scene for no more than 10 minutes for a critical
trauma patient.
33. What is the treatment for symptomatic bradycardia?
A: Atropine 0.5 mg IV/IO (repeat up to 3 mg). If ineffective, transcutaneous pacing or
dopamine/epinephrine infusions.
34. Describe the signs of severe opioid overdose.
A: CNS depression (coma), respiratory depression (slow, shallow, or absent), pinpoint pupils,
bradycardia, hypotension.
35. What is the antidote for opioid overdose?
A: Naloxone (Narcan).
36. What is the initial fluid resuscitation for hemorrhagic shock in trauma?
A: Balanced blood products (1:1:1 ratio of RBCs:Plasma:Platelets) if available, or 1-2 L bolus of
warmed crystalloid (e.g., Lactated Ringer's), per permissive hypotension protocols if
appropriate.
37. What is "permissive hypotension"?
A: Allowing a lower-than-normal BP (e.g., SBP 80-90 mmHg) in trauma patients with
uncontrolled hemorrhage until surgical control is achieved, to avoid disrupting clots and
worsening bleeding.
38. What is a key sign of cardiac tamponade?
A: Beck's Triad: Hypotension, distended neck veins (JVD), muffled heart sounds. Also may see
pulsus paradoxus.
39. What is the priority treatment for a STEMI patient?
A: ASA, Nitroglycerin (if BP permits), Oxygen (if hypoxic), Morphine for pain, and rapid transport
to a PCI-capable facility. Monitor for and treat arrhythmias.
40. What are the signs of a severe asthma attack (status asthmaticus)?
A: Altered mental status, fatigue, silent chest (no wheeze due to minimal airflow), hypoxia,
hypercarbia, use of accessory muscles, pulsus paradoxus.
41. What is the first-line medication for anaphylaxis?
A: Intramuscular Epinephrine (0.3-0.5 mg of 1:1,000 in the mid-anterolateral thigh).
