Free NREMT Practice Questions
Environmental Emergencies
Heat, cold, drowning, CO, and envenomation. Treat exposure plus physiology under protocol constraints.
What you'll master
- ✓Recognition and immediate stabilization
- ✓Rewarming/cooling priorities
- ✓Oxygen and transport triggers
- ✓Scene hazard mitigation
Common misses
- –Underestimating CO risk
- –Delayed rewarming/cooling
- –Missing drowning complications
Sample questions.
25 free environmental emergencies questions with answers and explanations. MedRelay's full question bank covers every NREMT domain, plus live scenarios that grade the decision, not just the answer.
Question 1
At a church basement, a 63-year-old male is bitten by a snake and has swelling around the bite. What is appropriate care?
Why:Correct. Keep the patient calm, limit movement, remove constricting items, and transport.
Question 2
Multiple lightning-strike patients are down. One is pulseless and apneic. What triage principle applies?
Why:Correct. Lightning arrest may be reversible with prompt ventilation, CPR, and AED use, so reverse triage may apply.
Question 3
You respond to a 48-year-old male who was in the ocean and had a close encounter with a jellyfish. He has raised linear welts across his right arm with intense burning pain. His skin is erythematous. HR 108, BP 118/76, SpO2 97%. He is not having systemic reactions. His companion suggests urinating on the sting. What is the evidence-based management?
Why:Correct. Urine (hypotonic) and fresh water trigger remaining nematocyst discharge — both are contraindicated. Seawater rinse does not trigger discharge. Tentacle removal with a barrier (gloves, card). Hot water immersion (as hot as tolerable without burning) inactivates venom proteins. Monitor for systemic anaphylaxis — this patient currently has only localized effects.
Question 4
A hiker has a frozen hand and rescue says evacuation will take hours in freezing weather. What should you avoid?
Why:Correct. Do not rewarm frostbite if refreezing is likely. Protect the part and prevent further injury.
Question 5
At a dialysis center, a 68-year-old male drowning patient is awake but coughing and short of breath. What should you recommend?
Why:Correct. Drowning patients can worsen later. Monitor breathing, provide oxygen if needed, and transport.
Question 6
At a grocery store, a 36-year-old female frostbitten hand may refreeze before arrival at the hospital. What should you avoid?
Why:Correct. Do not rewarm frostbite if refreezing may occur.
Question 7
A frostbitten foot has hard waxy skin. Transport will be short. What should you do?
Why:Correct. Protect frostbitten tissue, keep it dry, prevent refreezing, and transport. Do not rub or use direct heat.
Question 8
You respond to a mountain trail where a 28-year-old female hiker was found at an elevation of 3400 meters. She has been at altitude for 36 hours and now has a severe headache, ataxia, and her partner says she is confused and seeing double. SpO2 is 76% on room air. HR 128. She has crackles bilaterally in her lungs. What is the single most important prehospital treatment?
Why:Correct. HACE plus HAPE at 3400 meters is immediately life-threatening. SpO2 76% is a medical emergency. Descent is the single most important and definitive treatment — every meter of descent reduces atmospheric hypoxia. High-flow oxygen during descent. Portable hyperbaric chambers if available. Every minute at altitude worsens the condition.
Question 9
At a office lobby, a 58-year-old female has severe sunburn with blistering over the back and weakness. What is an EMT-B priority?
Why:Correct. Significant burns require cooling if appropriate, dry sterile covering, shock assessment, and transport.
Question 10
You respond to a campsite where a 31-year-old male was bitten on the ankle by a rattlesnake 45 minutes ago. The ankle is massively swollen with a visible fang mark and spreading ecchymosis. HR is 118, BP is 96/66, and he is nauseous and dizzy. His ankle circumference is increasing. What is the correct prehospital management?
Why:Correct. Rattlesnake envenomation management: immobilize the extremity (reduces lymphatic spread), keep at or below heart level, remove constrictive items, keep calm (reduces heart rate and venom spread), Priority 1 transport for antivenom. Tourniquets concentrate venom causing tissue necrosis. Cut-and-suck removes less than 2% of venom while introducing infection. Ice causes vasoconstriction worsening tissue injury.
Question 11
At a bus terminal, a 54-year-old female has severe sunburn with blistering over the back and weakness. What is an EMT-B priority?
Why:Correct. Significant burns require cooling if appropriate, dry sterile covering, shock assessment, and transport.
Question 12
At a dialysis center, a 67-year-old male shivering hypothermic patient is confused after being found wet outdoors. What should you do?
Why:Correct. Remove wet clothing, prevent heat loss, handle gently, and warm gradually.
Question 13
A hypothermic patient is found outdoors, bradycardic and confused. What handling principle matters?
Why:Correct. Hypothermic patients should be moved gently to reduce risk of arrhythmia and further heat loss.
Question 14
At a manufacturing floor, a 59-year-old male diver has chest pain, dizziness, and joint pain after surfacing. What should you suspect?
Why:Correct. Symptoms after diving can indicate decompression illness and need oxygen and specialized care.
Question 15
At a college dorm, a 20-year-old female lightning-strike patient is apneic and pulseless. Other patients are awake. What is appropriate?
Why:Correct. Lightning arrest can be reversible. Begin CPR and AED use when safe.
Question 16
You respond to a youth soccer game on a hot humid day. A 10-year-old male player collapsed on the field. He is conscious and confused. His skin is hot and dry. Temperature is 41.2 degrees C rectally. HR 152, BP 84/54. He stopped sweating about 20 minutes ago per his coach. This is heat stroke. When should you STOP active cooling to prevent overshoot?
Why:Correct. Heat stroke cooling endpoint is 39.4 degrees C (103 degrees F). After stopping active cooling the temperature continues to drift downward from residual surface cooling. Cooling to 37 degrees C will overshoot into hypothermia. Monitor temperature continuously and stop cooling at the 39.4 degree endpoint.
Question 17
At a restaurant, a 33-year-old male drowning patient is awake but coughing and short of breath. What should you recommend?
Why:Correct. Drowning patients can worsen later. Monitor breathing, provide oxygen if needed, and transport.
Question 18
A hiker has been lost for 2 days in -8 degrees C weather. Core temperature is 30 degrees C. He is not shivering. What does absent shivering at 30 degrees C indicate and how does it guide rewarming?
Why:Correct. Shivering ceases below 30-32 degrees C when thermogenic capacity is exhausted. At 30 degrees C the myocardium is critically irritable — rough handling or heat packs can precipitate VF. Gentle passive rewarming: dry insulating blankets, remove wet clothing, protect from cold. No external heat packs (cause peripheral vasodilation worsening hemodynamics). Handle as if made of glass.
Question 19
At a clinic waiting room, a 63-year-old male has an allergic reaction after multiple wasp stings. Which finding would indicate anaphylaxis?
Why:Correct. Respiratory compromise or hypotension with allergic symptoms indicates anaphylaxis.
Question 20
At a manufacturing floor, a 58-year-old male is bitten by a snake and has swelling around the bite. What is appropriate care?
Why:Correct. Keep the patient calm, limit movement, remove constricting items, and transport.
Question 21
You respond to a beach boardwalk for a 16-year-old female who stepped on a stingray while wading in shallow water. She has a puncture wound on the dorsum of her right foot with severe pain rated 10/10. She is otherwise well with stable vital signs and no anaphylaxis signs. Her friend says you should apply ice to relieve the pain. You disagree. What is the correct counter-argument?
Why:Correct. Stingray envenomation — hot water not ice: stingray venom is heat-labile. Hot water at 43-45 degrees C denatures the venom proteins, inactivating them. Ice causes vasoconstriction that reduces venom clearance and worsens ischemic pain from vascular spasm. Hot water immersion typically produces dramatic pain relief within minutes. Continue for 30-90 minutes or until pain resolves. Transport for wound debridement.
Question 22
You respond to a campsite where a 24-year-old male was found after spending the night outdoors in -15 degrees C weather. His right foot appears waxy, white, and firm to the touch. He cannot feel it. When you gently press the tissue it does not blanch or show capillary refill. He is conscious with GCS 15 and other vital signs are normal. What is this injury and what is the critical field management principle?
Why:Correct. Severe frostbite management: the absolute rule — do not rewarm if there is any risk of re-freezing. Rewarming then re-freezing causes far worse cellular injury from repeated ice crystal formation than remaining frozen. If the patient can walk and may re-expose the foot, leave it frozen. Protect from mechanical trauma (do not rub). Transport for controlled hospital rewarming.
Question 23
At a clinic waiting room, a 62-year-old male diver has chest pain, dizziness, and joint pain after surfacing. What should you suspect?
Why:Correct. Symptoms after diving can indicate decompression illness and need oxygen and specialized care.
Question 24
You respond to a lake where a 16-year-old male was jet skiing and was ejected at high speed. He is found floating face-up. He is unconscious and apneic. Bystanders have removed him from the water. He is pulseless. The water temperature is 18 degrees C (64 degrees F). He has been in the water for an estimated 5-6 minutes. A bystander says he is probably brain dead after 5 minutes. What is your response?
Why:Correct. Drowning resuscitation: always initiate CPR for a drowning victim without obvious signs of irreversible death (rigor, decomposition, lividity). Water at 18 degrees C provides moderate cerebral cooling. Pediatric victims have greater recovery potential than adults. Bystander predictions of non-survival are not valid. Not dead until warm and dead applies to cold water drowning. Aggressive resuscitation is always indicated.
Question 25
At a farm driveway, a 70-year-old male is found in cold water and has slow respirations. What should you remember?
Why:Correct. Cold-water hypothermia requires gentle handling, airway support, and careful transport.
Keep going
The exam mixes domains. So should your practice.
Questions only get you so far.
Run a live environmental emergencies scenario and get graded on decision order and timing, not just the right answer — plus the full 2025 question bank and PCR training in Student Pro.