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10 free AEMT practice questions: Environmental Emergencies: Heat, Cold, and Submersion

These are real questions from the same bank the app draws from. Each one is written to the NREMT AEMT content specifications and kept inside the AEMT scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

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Question 1 of 10

A 48-year-old patient found unresponsive at a bus shelter in heat stroke has been cooled in the ambulance with packs and wet skin. The temperature has come down from 106.4°F to 102.2°F and the patient now tracks faces and follows a simple command. Transport time remaining is nine minutes. What should the crew do about the cooling?

Show the answer and rationale

Correct answer · Stop active cooling now and keep monitoring the patient

This heat stroke patient has reached the point where cooling stops. The temperature has come down from 106.4°F to 102.2°F, and the patient now tracks faces and follows a simple command. Cooling in heat stroke stops at about 102°F, above normal body temperature. If you keep cooling past that point, the patient can become hypothermic and start to shiver. Shivering is muscle work, and muscle work makes heat. The shivering undoes the cooling you just did. Take the packs off now and keep monitoring the patient.

Why the others are wrong

Continue cooling until the temperature reaches 98.6°F: Normal body temperature is 98.6°F, but heat stroke cooling stops well before normal. Cooling past 102°F causes hypothermia and shivering, and the shivering makes more heat.

Continue cooling until the patient is fully oriented: Full orientation is a good sign of recovery. Mental status comes back more slowly than the temperature comes down, and full recovery may not happen before the hospital. Waiting for full orientation would take the temperature well past 102°F.

Stop cooling and apply a blanket to bring the temperature up: A blanket is for a patient who is getting too cold. This patient is at 102.2°F, which is the target, not a problem to fix. A blanket now traps heat in a patient whose body still cannot control its own temperature well.

Question 2 of 10

A 28-year-old patient is walked into the first aid tent at an outdoor festival after going down in the crowd. A friend says the patient had been drenched in sweat twenty minutes ago. The skin is now hot and dry to the elbow and the shin, the patient is agitated and cannot follow a simple command, and the vital signs are BP 100/58, P 132, R 26, T 105.0°F, and SpO₂ 96% on room air. What has changed in this patient?

Show the answer and rationale

Correct answer · Thermoregulation has failed and this is now heat stroke

This patient's thermoregulation has failed, and this is now heat stroke. A friend says the patient was drenched in sweat twenty minutes ago. Now the skin is hot and dry, and the temperature is 105.0°F. Sweating is how the body gets rid of heat. A patient who is getting hotter and stops sweating has stopped cooling, and the patient is getting worse. The patient is also agitated and cannot follow a simple command. Heat stroke is a temperature of 104°F or higher with hot, dry skin, plus an altered mental status. This patient has both. The heavy sweating earlier was heat exhaustion, when the body was still keeping up. Start cooling right there in the tent.

Why the others are wrong

The volume loss has deepened into a simple faint from heat: A faint from heat is when the patient goes down and comes back with a clear head. This patient is agitated, cannot follow a command, and is at 105.0°F. Those findings go far past a simple faint.

The sweat has dried in the breeze and the illness is unchanged: Sweat can dry off in a breeze. Dry skin at 105.0°F with new confusion is not sweat that dried off. Writing off the dry skin as the breeze delays the cooling this patient needs.

A low blood glucose level has been added to the heat illness: A low blood glucose is always worth checking in an agitated patient. Low glucose does not explain a temperature of 105.0°F or skin that has stopped sweating.

Question 3 of 10

A 72-year-old patient sits in the shade at a community cooling center with moist skin, a steady pulse, and full, correct answers to every question. The crew is treating this as heat exhaustion and is giving oral fluid while a second unit finishes another call. Which change in this patient would mean the condition has crossed into heat stroke?

Show the answer and rationale

Correct answer · The sweating stops and the patient becomes confused

Sweating that stops and new confusion mean this patient has crossed into heat stroke. Right now this patient has moist skin, a steady pulse, and correct answers to every question. Those findings are heat exhaustion. The body is still sweating to get rid of heat, and the brain is getting enough blood and oxygen to answer correctly. When the sweating stops, the body has lost its way to cool itself, and the core temperature keeps climbing. Confusion means the heat is now affecting the brain. Heat stroke is a core temperature of 104°F or higher with an altered mental status. Once this patient crosses into heat stroke, shade and oral fluids are not enough. The patient needs aggressive cooling and fast transport.

Why the others are wrong

The pulse climbs by twenty while the patient stays alert: A pulse that climbs by twenty fits worsening heat exhaustion, from fluid loss and more heat. The patient is still alert, so the brain is still getting enough blood and is still cool enough to work. A fast pulse without a change in mental status is not heat stroke.

The patient reports a worse headache and more nausea: A worse headache and more nausea are findings that already belong to heat exhaustion. Worse symptoms within heat exhaustion mean the patient needs closer watching and faster cooling. Those symptoms do not change the diagnosis.

The patient develops cramping in both thighs and calves: Cramping in both thighs and calves is classic for heat cramps. Heat cramps come from losing sodium and water in sweat. Cramps sit at the mild end of heat illness and do not mean the body has stopped cooling itself.

Question 4 of 10

An 81-year-old patient is pulled from a flooded creek bank after several hours in the water and the wind. The patient is soaked, rigid, and responds only to pain. T 83.1°F. One crew member wants the wet layers off immediately and is reaching to sit the patient up and pull the jacket over the head. What is the correct way to get the wet clothing off this patient?

Show the answer and rationale

Correct answer · Cut the clothing away with the patient kept flat and moved gently

Cut the wet clothing away while you keep the patient flat and move the patient gently. This patient has hypothermia. The temperature is 83.1°F, and the patient is rigid and responds only to pain. Wet clothing keeps pulling heat out of the body, so the wet layers have to come off fast. A heart this cold is also irritable. Rough movement or jostling can push a cold heart into ventricular fibrillation. That's why this patient stays flat and gets moved gently. Cutting the clothing gets the layers off as fast as pulling them would. You do not have to sit the patient up, roll the patient, or yank on a sleeve.

Why the others are wrong

Leave the wet layers on and wrap blankets over them for the ride: Blankets help a cold patient once the wet layers are off. Over soaked clothing, the blankets hold the wet layers against the skin. The wet layers keep pulling heat out, and the patient keeps cooling under the blanket.

Sit the patient up and pull each layer off, then lay the patient flat: Pulling each layer off is fast, and speed does matter here. Sitting up a patient at 83.1°F and pulling a jacket over the head jostles the patient hard. That jostling can push a cold heart into ventricular fibrillation.

Stand the patient briefly so the soaked layers fall away cleanly: Standing the patient up is worse than sitting the patient up. This patient responds only to pain and cannot hold any weight. You would have to handle the patient roughly just to keep the patient upright.

Question 5 of 10

A 19-year-old patient is found at a trailhead after being lost overnight in freezing rain, shivering only faintly, slow to answer, and cold to the trunk. T 88.2°F. The ambulance is parked about sixty feet away on level ground, and the patient says walking there would be no trouble. What should the crew do?

Show the answer and rationale

Correct answer · Carry the patient flat to the ambulance and keep the patient horizontal

This patient has hypothermia. The temperature is 88.2°F, the shivering is faint, and the patient is slow to answer. A heart muscle that cold is irritable. Rough movement or jostling can set off ventricular fibrillation. Walking also pushes cold blood from the working legs back to the core. That's why you move a hypothermic patient gently and keep the patient horizontal. The patient saying the walk would be no trouble does not change how cold the heart is. Carry the patient flat to the ambulance, even for sixty feet of level ground.

Why the others are wrong

Let the patient walk slowly with a crew member on each side: A crew member on each side keeps the patient from falling. The patient is still walking. The exertion and the upright position are what put the cold heart at risk, and the escorts do not change either one.

Have the patient stand and take a few steps to test the balance: Testing balance makes sense when you are deciding if a patient can walk safely. This patient should not walk at all. A few test steps are still exertion, and no small number of steps is safe for a cold, irritable heart.

Have the patient walk while the crew watches the level of consciousness: Watching the level of consciousness is good practice with any hypothermic patient. Those checks only show you a problem after it starts. Ventricular fibrillation is not something you catch early by watching a patient walk.

Question 6 of 10

A 79-year-old patient with a core temperature of 84.6°F is being rewarmed in the ambulance. A newer crew member asks why hot packs are not placed along the arms and legs, since those feel the coldest. What is the reason extremity rewarming is avoided in this patient?

Show the answer and rationale

Correct answer · It returns cold, acidotic blood from the limbs to the core

This patient has moderate hypothermia, with a core temperature of 84.6°F. The blood out in the arms and legs is cold and acidotic. Warming the arms and legs sends that cold, acidotic blood back to the core. The cold blood cools the core even more. This is called afterdrop. That's why the hot packs go on the trunk, at the groin and armpits. Active rewarming of the arms and legs is avoided in moderate and severe hypothermia.

Why the others are wrong

It burns cold skin that cannot feel the heat being applied: Hot packs can burn skin that cannot feel heat. That risk is real anywhere you put a pack, the trunk included. Burn risk does not explain why only the arms and legs are skipped. The arms and legs are skipped because of afterdrop.

It uses up packs that the trunk will need later in transport: How many packs are left never decides where they go. The rule against warming the arms and legs comes from the cold, acidotic blood it sends back to the core.

It restarts shivering, and shivering raises oxygen demand: Shivering is how the body makes heat. At 84.6°F, this patient is in moderate hypothermia. Shivering is minimal or gone by this stage. Warming the arms and legs is avoided because of afterdrop, not because of shivering.

Question 7 of 10

A 13-year-old patient is brought inside after a long afternoon sledding in wet jeans. The child is shivering hard, complains of being cold, is alert and clumsy with the zipper, and the vital signs are BP 110/68, P 104, R 20, T 93.6°F, and SpO₂ 99% on room air. Which stage of hypothermia does this child fit?

Show the answer and rationale

Correct answer · Mild, because the shivering is vigorous and the child is alert

This child has mild hypothermia. The temperature is 93.6°F, and mild hypothermia runs from about 90 to 95°F. The child is shivering hard and is alert. Shivering is the muscles making heat. The body only shivers hard while the brain can still run its own warming response. As the cold gets worse, the shivering stops. Vigorous shivering in a child who is alert tells you this is still mild hypothermia. Passive rewarming is the treatment. Take off the wet jeans, dry the skin, and cover the child to hold in heat. Let the shivering do the work. Active external rewarming is for moderate and severe cases.

Why the others are wrong

Severe, because the temperature is well under normal: Severe hypothermia is below about 82°F. Those patients are unresponsive, the muscles are rigid, and the shivering has stopped because the body cannot make heat anymore. This child is alert, shivering hard, and at 93.6°F.

Moderate, because the child is clumsy with the hands: Fine motor control does get worse as the core temperature drops, so clumsy hands can look like moderate hypothermia. Moderate hypothermia runs from about 82 to 90°F. With moderate hypothermia, the shivering stops and the level of consciousness falls. This child is shivering hard and fully alert at 93.6°F, so the clumsy hands still fit mild hypothermia.

No hypothermia, because the child is alert and talking: A temperature of 93.6°F is hypothermia, even in a child who is alert and talking. Mental status changes come later, as the temperature drops into the moderate and severe ranges. Calling this child normal leaves the wet jeans on, and the core temperature keeps falling.

Question 8 of 10

A 5-year-old patient is pulled from a backyard pool after going under for about a minute. The child is awake and moves all four limbs, and a neighbor watched the child jump in feet first. There is water and vomit at the mouth, and each breath makes a gurgling sound. The vital signs are BP 96/60, P 136, R 32, and SpO₂ 91% on room air. Which action comes first for this child?

Show the answer and rationale

Correct answer · Suction the airway and keep the suction at hand for vomiting

This child has fluid in the upper airway after a submersion. There is water and vomit at the mouth, and each breath makes a gurgling sound. Gurgling means fluid is sitting in the upper airway. Submersion is an oxygen problem, and right after the rescue the oxygen problem is in the airway. Water, debris, and stomach contents all end up in the mouth. These patients also vomit at a very high rate. Oxygen cannot reach the lungs through an airway full of water and vomit. Suction the airway first and keep the suction where you can grab it. Then move on to oxygen and warming.

Why the others are wrong

Remove the wet clothing and wrap the child in dry blankets: Every submersion patient is losing heat, and getting the wet clothing off is real treatment. Warming still comes after clearing a mouth that has water and vomit in it.

Apply an NRB at a high concentration of oxygen: This child does need oxygen, with an SpO₂ of 91% on room air. Oxygen comes second, because every breath has to pass through the water and vomit in the mouth.

Hold manual spinal stabilization and fit a cervical collar: Spinal stabilization is right for a dive or for an entry nobody saw. A neighbor watched this child jump in feet first. A collar does nothing for this child while the suction waits.

Question 9 of 10

An 82-year-old patient fell from a boat dock into a lake and is holding onto a piling about twenty five feet out, calling for help and keeping the head above the water. The crew carries a throw rope and a long reach pole, and the nearest water rescue team is twenty minutes away. How should the crew attempt this rescue?

Show the answer and rationale

Correct answer · Throw the rope or extend the pole from the dock and pull the patient in

This is a water rescue, and the order is reach, throw, row, then go. A pole or a rope comes before anyone gets in the water. A rescuer in the water becomes a second patient. Rescuers who go in and drown are a repeated cause of death at these scenes. This patient is awake, holding onto a piling, and keeping the head above the water. The patient is twenty five feet from the dock you are standing on. Twenty five feet is reach and throw distance. Extend the pole or throw the rope, and pull the patient in from the dock. Going in the water is the last step on the list.

Why the others are wrong

Swim out with a flotation device and tow the patient back to the dock: A trained water rescue swimmer might swim out with a flotation device. This crew is not the water rescue team. A patient in the water grabs and climbs on whoever reaches them. The rescuer who has to fight that off is the next person under the water.

Enter the water with a rope around the waist and walk the patient in: The rope is the right tool, and tying in is a good idea. Getting in the water is still the problem. Cold water, a drop off you cannot see, and a frightened patient are all waiting for whoever steps in.

Wait for the water rescue team and keep talking to the patient meanwhile: Waiting for the water rescue team is right when nothing on scene can reach the patient. This crew already has a pole and a rope in hand. Twenty minutes is a long time for an 82-year-old patient to hold onto a piling.

Question 10 of 10

An 84-year-old patient was pulled from an irrigation canal after slipping down the bank while walking a dog. The air temperature is 58°F. The patient is awake and shivering, is still in soaked clothing, and a first responder has laid a blanket over the top of it. The vital signs are BP 142/84, P 104, R 22, and SpO₂ 94% on room air. What should the crew do about the heat this patient is losing?

Show the answer and rationale

Correct answer · Take the wet clothing off, dry the skin, and cover with dry blankets

This patient has hypothermia. The patient came out of an irrigation canal, is shivering, and is still in soaked clothing under the blanket. The wet clothing matters more than the 58°F air. Water pulls heat away from the skin many times faster than air does. Wet fabric holds that water right against the skin. A blanket over the top only insulates the water. The skin underneath keeps losing heat. Take the wet clothing off, dry the skin, and cover the patient with dry blankets. Removing the wet layers stops the heat loss. Any warming you do after that reaches the patient instead of the water.

Why the others are wrong

Add a second blanket over the wet clothing and turn the cabin heat up: Blankets and cabin heat are part of treating hypothermia once the patient is dry. This patient's clothing is still soaked. A second blanket and a warmer cabin only warm the air around a wet layer. The wet layer keeps pulling heat from the skin.

Leave the clothing in place and put warm packs over both arms and legs: Warm packs are a real rewarming tool. Warm packs belong over the trunk, armpits, and groin, not the arms and legs. They also go on only after the wet clothing comes off. With the clothing still on, the packs warm the water instead of the skin.

Dry the outside of the clothing with towels and keep the blanket on top: Toweling off the outside of the clothing leaves the wet layer against the skin. The skin keeps losing heat to that water the same as before.

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