Air Medical Transport Practice Questions

25 multiple-choice questions on Air medical transport for paramedic and EMT students, from Chapter 47 (Transport Operations). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A 40-year-old crash patient is alert with a GCS of 15, normal vital signs, and a deformed forearm. A trauma center is 15 minutes away by ground, and a helicopter is offered. The best choice is:

   1. A. Air transport to save a few minutes
   2. B. Ground transport to the trauma center
   3. C. Air transport because of the crash mechanism
   4. D. Waiting on scene for a flight crew to assess
   Show answer

   Answer: B. Ground transport to the trauma center

   A stable patient close to definitive care gains nothing from flight, which adds cost and the risk of an air medical crash. Mechanism alone, without physiologic or anatomic triage criteria, does not justify air transport.

2. Your patient needs a helicopter, but the crash site is in a wooded ravine. The best plan is to:

   1. A. Meet the aircraft at a nearby safe landing zone
   2. B. Ask the pilot to land on the narrow road nearby
   3. C. Wait until the pilot finds a spot in the trees
   4. D. Carry the patient to the nearest highway shoulder
   Show answer

   Answer: A. Meet the aircraft at a nearby safe landing zone

   A rendezvous at a prearranged, secured landing zone (often set up by fire crews) lets the ground unit carry the patient to the aircraft safely. Narrow roads and tree openings are hazardous for rotor clearance.

3. A helicopter is requested for a patient in traumatic cardiac arrest at a crash scene with no return of pulses. The main concern with flying this patient is that:

   1. A. Defibrillation is not allowed during flight
   2. B. Altitude itself makes chest compressions fail
   3. C. Survival is very poor and flight adds risk
   4. D. Air transport is legally barred in arrest
   Show answer

   Answer: C. Survival is very poor and flight adds risk

   Traumatic arrest without ROSC has very low survival, and CPR is hard to perform in a cramped aircraft, so most programs do not fly these patients. Flight crews are trained and equipped for arrest and can defibrillate in flight, and the difficulty with compressions comes from the cramped cabin rather than altitude; the issue is benefit versus risk.

4. Which patient is most likely to be refused by a flight crew before they are decontaminated?

   1. A. A patient with a femur fracture in traction
   2. B. A patient with an STEMI on a heparin drip and nitroglycerin
   3. C. A patient with a known HIV infection
   4. D. A patient soaked in organophosphate pesticide
   Show answer

   Answer: D. A patient soaked in organophosphate pesticide

   Contaminated hazmat patients can poison the flight crew in a small, enclosed cabin and must be fully decontaminated first. HIV, fractures, and drips are routinely managed by flight teams.

5. A combative, intoxicated head-injured patient is to be flown. Before loading, the flight crew will most likely:

   1. A. Sedate or restrain him before flight
   2. B. Refuse him because of the head injury
   3. C. Fly him without restraints to avoid harm
   4. D. Fly him seated next to the pilot
   Show answer

   Answer: A. Sedate or restrain him before flight

   A combative patient can injure the crew or interfere with the pilot, so flight teams typically sedate, intubate, or fully restrain such patients. Head injury itself is a common reason to fly, not a reason to refuse.

6. The decision whether conditions are safe to fly should be made by the pilot:

   1. A. After hearing how critical the patient's condition is
   2. B. Without knowing the patient's condition
   3. C. After the receiving hospital approves
   4. D. Based on the requesting crew's judgment
   Show answer

   Answer: B. Without knowing the patient's condition

   Air medical programs keep patient details from the pilot during the go/no-go decision, so a tragic story cannot pressure the pilot into flying in unsafe weather. Hearing how critical the patient is would bring back that pressure, the receiving hospital has no role in judging flight safety, and the requesting ground crew cannot judge aviation weather or aircraft limits.

7. You request a helicopter and the first service declines because of weather. When you call a second service, you should:

   1. A. Tell them the first service declined
   2. B. Not mention the first service's decision
   3. C. Insist that the patient will die without it
   4. D. Ask them to fly lower than usual to stay under the fog
   Show answer

   Answer: A. Tell them the first service declined

   Disclosing that another program declined for weather prevents 'helicopter shopping,' a factor in fatal air medical crashes. Pressuring the pilot or withholding information puts the crew at risk.

8. Your landing zone is a dry, dusty dirt field. The best step before the helicopter lands is to:

   1. A. Lay tarps over the dirt to hold it down
   2. B. Sweep the dust into piles at the edges
   3. C. Wet the surface and warn the pilot
   4. D. Park the ambulance in the middle of it
   Show answer

   Answer: C. Wet the surface and warn the pilot

   Rotor wash can raise a dust 'brownout' that blinds the pilot; wetting the surface (often with an engine) and warning the pilot reduce the risk. Tarps blow away and become projectiles.

9. You are setting up a landing zone in an open field at night. The best way to mark it is with:

   1. A. Road flares placed in a circle in dry grass
   2. B. Light sheets laid flat at the four corners
   3. C. A vehicle's high beams aimed at the aircraft
   4. D. Weighted lights or cones at each corner
   Show answer

   Answer: D. Weighted lights or cones at each corner

   Weighted cones or strobes at the corners outline the zone without blowing away or starting fires. Flares can ignite dry grass, loose sheets become projectiles in rotor wash, and lights aimed at the aircraft blind the pilot.

10. As the helicopter approaches your landing zone at night, a firefighter aims a spotlight up at the aircraft to help the pilot. You should:

    1. A. Have him keep it on the aircraft until it has landed
    2. B. Have it turned off or aimed at the ground
    3. C. Add more lights aimed upward for visibility
    4. D. Tell him to flash it on and off as a signal
    Show answer

    Answer: B. Have it turned off or aimed at the ground

    White lights pointed at the aircraft can blind the pilot or wash out night vision goggles. Scene lights should point at the ground and away from the approach path.

11. The pilot circles your landing zone and decides to land at a different spot nearby. You should:

    1. A. Insist the pilot use your chosen spot
    2. B. Accept it, since the pilot has final say
    3. C. Move your crew under the new approach
    4. D. Light flares to guide the pilot back
    Show answer

    Answer: B. Accept it, since the pilot has final say

    The pilot makes the final decision on whether and where to land based on what can be seen from the air. Move bystanders and crews away from the new approach path, not under it.

12. A 'hot load' at a helicopter means the patient is loaded:

    1. A. After the engine is fully shut down
    2. B. Inside a heated cabin for comfort
    3. C. Through the rear clamshell doors
    4. D. With the rotors still turning
    Show answer

    Answer: D. With the rotors still turning

    Hot loading with the rotors turning saves time but carries a higher risk, so it is done only under the flight crew's direction. A cold load is done after the rotors stop.

13. A helicopter lands on a slight hill. To approach it, you should come from the:

    1. A. Uphill side, where you can see the pilot
    2. B. Rear, where the slope is least steep
    3. C. Downhill side, where the rotor is higher
    4. D. Side closest to the tail, out of the pilot's way
    Show answer

    Answer: C. Downhill side, where the rotor is higher

    On a slope, the main rotor dips closer to the ground on the uphill side, so you approach from the downhill side. The rear and tail rotor are never approached.

14. Carrying an IV bag to a helicopter with the rotors turning, you should hold it:

    1. A. Low as you crouch
    2. B. High above your head so it flows
    3. C. Up where the crew can see it
    4. D. On a tall pole beside the cot
    Show answer

    Answer: A. Low as you crouch

    Anything raised overhead can contact the main rotor. Carry IV bags, poles, and equipment low and horizontal; a brief drop in IV flow is far safer than a rotor strike.

15. Ground personnel working near a helicopter should keep bystanders and vehicles at least about:

    1. A. 10 to 20 feet away for quick access
    2. B. 500 to 1,000 feet away from the zone
    3. C. 100 to 200 feet away from the zone
    4. D. Close enough to help with lifting
    Show answer

    Answer: C. 100 to 200 feet away from the zone

    Bystanders and vehicles are kept well back (often 100 to 200 feet) from the landing zone to avoid rotor wash and debris. Only trained personnel enter the zone, and only when directed.

16. A patient with a chest injury is to be flown at 5,000 feet in an unpressurized helicopter. The gas law that explains why a small pneumothorax may enlarge is:

    1. A. Dalton's law
    2. B. Henry's law
    3. C. Charles's law
    4. D. Boyle's law
    Show answer

    Answer: D. Boyle's law

    Boyle's law: at a constant temperature, gas volume varies inversely with pressure, so as pressure falls with altitude, air trapped in the pleural space expands and a small pneumothorax can enlarge. Dalton's law describes partial pressures and explains the fall in oxygen, Henry's law describes gas dissolved in liquid (as in decompression sickness), and Charles's law relates gas volume to temperature.

17. An intubated patient will be flown at altitude. To prevent the endotracheal tube cuff from overexpanding, the crew may:

    1. A. Fill the cuff with saline or monitor it
    2. B. Inflate the cuff with extra air before takeoff
    3. C. Deflate the cuff fully during the flight
    4. D. Replace the tube with a nasal airway
    Show answer

    Answer: A. Fill the cuff with saline or monitor it

    Air in the cuff expands as cabin pressure falls (Boyle's law), which can damage the trachea; filling with saline or checking and adjusting cuff pressure prevents it. Deflating the cuff risks aspiration and air leaks.

18. A patient's SpO2 falls from 96% to 90% as an unpressurized aircraft climbs. This change is best explained by:

    1. A. Boyle's law, as gas in the lungs expands
    2. B. Dalton's law, as oxygen partial pressure falls
    3. C. Henry's law, as nitrogen comes out of the blood
    4. D. Charles's law, as cabin temperature drops
    Show answer

    Answer: B. Dalton's law, as oxygen partial pressure falls

    Dalton's law: the percentage of oxygen stays at 21%, but falling total pressure lowers the partial pressure of oxygen, so arterial saturation drops. Increase supplemental oxygen to compensate.

19. A patient is flown in a pressurized fixed-wing air ambulance cruising at 30,000 feet. The crew still watches for hypoxia and gas expansion because the cabin is usually pressurized to about:

    1. A. A sea-level cabin altitude
    2. B. A 6,000- to 8,000-ft cabin altitude
    3. C. A 20,000- to 25,000-ft cabin altitude
    4. D. The same 30,000 ft as outside
    Show answer

    Answer: B. A 6,000- to 8,000-ft cabin altitude

    Pressurized aircraft normally hold the cabin at an equivalent altitude of up to about 8,000 feet (the FAA limit in normal operation), not at sea level, so trapped gas still expands and the partial pressure of oxygen still falls. A sea-level cabin is possible only by flying lower, and it is requested for patients such as divers with decompression sickness. A 20,000- to 25,000-ft cabin would cause rapid hypoxia, and a cabin at the outside altitude would mean pressurization had failed.

20. A patient is going to be flown with an air splint on the leg. During the climb, the crew should watch for:

    1. A. The splint losing air at altitude
    2. B. Cooling of the splint that causes frostbite
    3. C. The splint becoming rigid and cracking
    4. D. Increasing splint pressure on the limb
    Show answer

    Answer: D. Increasing splint pressure on the limb

    Air splints expand as pressure falls with altitude and can compress the limb; crews check pulses and adjust pressure. They deflate somewhat on descent.

21. A patient with bowel obstruction and vomiting is to be flown. Before flight, placing a gastric tube helps because it:

    1. A. Prevents motion sickness during flight
    2. B. Raises oxygen saturation at altitude
    3. C. Vents gas that expands with altitude
    4. D. Reduces the need for IV fluids
    Show answer

    Answer: C. Vents gas that expands with altitude

    Trapped gas in the stomach and bowel expands at altitude (Boyle's law), increasing pain, vomiting, and aspiration risk. A gastric tube vents air and fluid.

22. The flight crew tells you it is hard to hear breath sounds during flight. They rely more on:

    1. A. Monitors such as SpO2, ETCO2, and ECG
    2. B. Listening with an extra stethoscope
    3. C. Asking the patient to report changes they feel
    4. D. Guessing based on skin color alone
    Show answer

    Answer: A. Monitors such as SpO2, ETCO2, and ECG

    Rotor noise and vibration make auscultation unreliable, so flight teams depend on continuous monitoring such as waveform capnography and pulse oximetry. Patients may also be unable to hear or speak to the crew.

23. A fixed-wing aircraft rather than a helicopter is usually chosen when:

    1. A. The patient is at a crash scene in the woods
    2. B. No airport is within 100 miles of either hospital
    3. C. Transfer distances are long, often over 150 miles
    4. D. The patient needs a scene landing at night
    Show answer

    Answer: C. Transfer distances are long, often over 150 miles

    Fixed-wing aircraft fly faster and farther than helicopters but need runways, so they suit long interfacility transfers. Scene responses and short hops use helicopters.

24. Ground crews preparing a patient for flight should keep in mind that the cabin of a helicopter is:

    1. A. Roomy enough for full procedures during the flight
    2. B. Pressurized, so gas expansion is not a concern
    3. C. Quiet enough to hear breath sounds clearly
    4. D. Cramped, so secure airway and IVs first
    Show answer

    Answer: D. Cramped, so secure airway and IVs first

    Limited space, noise, and vibration make in-flight procedures difficult, so the airway, IV lines, and splints should be secured before loading. Most helicopters are unpressurized, so trapped gas expands with altitude, and rotor noise makes breath sounds hard to hear. Altitude and open doors can also chill patients.

25. Before a patient is loaded into a helicopter, loose items such as blankets and sheets on the cot should be:

    1. A. Removed and left on the ground at the zone
    2. B. Tucked in or strapped down
    3. C. Held up by bystanders to block the wind
    4. D. Thrown to the side once the aircraft lands
    Show answer

    Answer: B. Tucked in or strapped down

    Rotor wash can lift loose sheets and blankets into the rotor system or into personnel. Secure them under the straps or remove them per the flight crew's direction before approaching the aircraft.