NCOEMS Practice Exam 2026/2027
North Carolina Office of Emergency Medical Services
Actual Exam
EMT & Paramedic Certification Practice Examination
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100 Multiple-Choice Questions
2026
This practice examination covers all domains tested on the
North Carolina OEMS EMT and Paramedic certification exams.
Correct answers are displayed in bold cyan blue text.
,Table of Contents
Table of Contents ..................................................................................................................... 2
EMS Systems & Operations .................................................................................................... 4
Airway Management & Ventilation ....................................................................................... 6
Patient Assessment ................................................................................................................... 8
Medical Emergencies — Cardiac ......................................................................................... 10
Medical Emergencies — Respiratory ................................................................................... 12
Medical Emergencies — Neurological ................................................................................. 15
Medical Emergencies — Endocrine ..................................................................................... 17
Medical Emergencies — Anaphylaxis & Toxicology .......................................................... 18
Medical Emergencies — Environmental ............................................................................. 20
Medical Emergencies — OB/GYN ....................................................................................... 22
Medical Emergencies — Behavioral .................................................................................... 25
Trauma — Hemorrhage Control.......................................................................................... 27
Trauma — Shock ................................................................................................................... 29
Trauma — Head & Spinal .................................................................................................... 31
Trauma — Chest Trauma ..................................................................................................... 33
Trauma — Abdominal & Musculoskeletal .......................................................................... 35
Trauma — Burns ................................................................................................................... 37
Special Populations — Pediatric ........................................................................................... 39
Special Populations — Geriatric, Bariatric, Disabilities .................................................... 41
Pharmacology ......................................................................................................................... 43
NC OEMS Protocols & Documentation............................................................................... 45
Answer Key ............................................................................................................................. 47
Table of Contents ..................................................................................................................... 2
EMS Systems & Operations .................................................................................................... 4
Page 2
,Airway Management & Ventilation ....................................................................................... 6
Patient Assessment ................................................................................................................... 8
Medical Emergencies — Cardiac ......................................................................................... 10
Medical Emergencies — Respiratory ................................................................................... 12
Medical Emergencies — Neurological ................................................................................. 15
Medical Emergencies — Endocrine ..................................................................................... 17
Medical Emergencies — Anaphylaxis & Toxicology .......................................................... 18
Medical Emergencies — Environmental ............................................................................. 20
Medical Emergencies — OB/GYN ....................................................................................... 22
Medical Emergencies — Behavioral .................................................................................... 25
Trauma — Hemorrhage Control.......................................................................................... 27
Trauma — Shock ................................................................................................................... 29
Trauma — Head & Spinal .................................................................................................... 31
Trauma — Chest Trauma ..................................................................................................... 33
Trauma — Abdominal & Musculoskeletal .......................................................................... 35
Trauma — Burns ................................................................................................................... 37
Special Populations — Pediatric ........................................................................................... 39
Special Populations — Geriatric, Bariatric, Disabilities .................................................... 41
Pharmacology ......................................................................................................................... 43
NC OEMS Protocols & Documentation............................................................................... 45
Answer Key ............................................................................................................................. 47
Page 3
, EMS Systems & Operations
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
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.
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
Rationale: Online medical direction (also called direct medical direction) involves real-time
communication between the EMS provider and a physician or approved medical control facility,
typically via radio or phone. Offline medical direction (indirect medical direction) consists of pre-
approved standing orders, protocols, and treatment guidelines that EMS providers follow without
needing to contact a physician for each patient encounter. Both forms are essential components of the
NC EMS medical direction system.
3. A paramedic in North Carolina is caring for a patient and wishes to deviate from the written
OEMS protocol. Which of the following statements is correct regarding protocol deviations?
Page 4
North Carolina Office of Emergency Medical Services
Actual Exam
EMT & Paramedic Certification Practice Examination
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━
100 Multiple-Choice Questions
2026
This practice examination covers all domains tested on the
North Carolina OEMS EMT and Paramedic certification exams.
Correct answers are displayed in bold cyan blue text.
,Table of Contents
Table of Contents ..................................................................................................................... 2
EMS Systems & Operations .................................................................................................... 4
Airway Management & Ventilation ....................................................................................... 6
Patient Assessment ................................................................................................................... 8
Medical Emergencies — Cardiac ......................................................................................... 10
Medical Emergencies — Respiratory ................................................................................... 12
Medical Emergencies — Neurological ................................................................................. 15
Medical Emergencies — Endocrine ..................................................................................... 17
Medical Emergencies — Anaphylaxis & Toxicology .......................................................... 18
Medical Emergencies — Environmental ............................................................................. 20
Medical Emergencies — OB/GYN ....................................................................................... 22
Medical Emergencies — Behavioral .................................................................................... 25
Trauma — Hemorrhage Control.......................................................................................... 27
Trauma — Shock ................................................................................................................... 29
Trauma — Head & Spinal .................................................................................................... 31
Trauma — Chest Trauma ..................................................................................................... 33
Trauma — Abdominal & Musculoskeletal .......................................................................... 35
Trauma — Burns ................................................................................................................... 37
Special Populations — Pediatric ........................................................................................... 39
Special Populations — Geriatric, Bariatric, Disabilities .................................................... 41
Pharmacology ......................................................................................................................... 43
NC OEMS Protocols & Documentation............................................................................... 45
Answer Key ............................................................................................................................. 47
Table of Contents ..................................................................................................................... 2
EMS Systems & Operations .................................................................................................... 4
Page 2
,Airway Management & Ventilation ....................................................................................... 6
Patient Assessment ................................................................................................................... 8
Medical Emergencies — Cardiac ......................................................................................... 10
Medical Emergencies — Respiratory ................................................................................... 12
Medical Emergencies — Neurological ................................................................................. 15
Medical Emergencies — Endocrine ..................................................................................... 17
Medical Emergencies — Anaphylaxis & Toxicology .......................................................... 18
Medical Emergencies — Environmental ............................................................................. 20
Medical Emergencies — OB/GYN ....................................................................................... 22
Medical Emergencies — Behavioral .................................................................................... 25
Trauma — Hemorrhage Control.......................................................................................... 27
Trauma — Shock ................................................................................................................... 29
Trauma — Head & Spinal .................................................................................................... 31
Trauma — Chest Trauma ..................................................................................................... 33
Trauma — Abdominal & Musculoskeletal .......................................................................... 35
Trauma — Burns ................................................................................................................... 37
Special Populations — Pediatric ........................................................................................... 39
Special Populations — Geriatric, Bariatric, Disabilities .................................................... 41
Pharmacology ......................................................................................................................... 43
NC OEMS Protocols & Documentation............................................................................... 45
Answer Key ............................................................................................................................. 47
Page 3
, EMS Systems & Operations
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
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.
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
Rationale: Online medical direction (also called direct medical direction) involves real-time
communication between the EMS provider and a physician or approved medical control facility,
typically via radio or phone. Offline medical direction (indirect medical direction) consists of pre-
approved standing orders, protocols, and treatment guidelines that EMS providers follow without
needing to contact a physician for each patient encounter. Both forms are essential components of the
NC EMS medical direction system.
3. A paramedic in North Carolina is caring for a patient and wishes to deviate from the written
OEMS protocol. Which of the following statements is correct regarding protocol deviations?
Page 4
