Questions test the underpinning-knowledge descriptors of phase 1a and 1b of the PHEM curriculum, whatever your own scope of practice. They are based on UK practice, guidelines and consensus statements.
The College publishes the intended spread across curriculum themes. It notes that the proportions may vary to some degree (Review, Table 2.2, p. 8):
Curriculum theme
Questions
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1. Working in emergency medical systems
18
10%
2. Providing pre-hospital emergency medical care
54
30%
3. Using pre-hospital equipment
18
10%
4. Supporting rescue and extrication
18
10%
5. Supporting safe patient transfer
18
10%
6. Supporting emergency preparedness and response
18
10%
A. Operational practice
9
5%
B. Team resource management
9
5%
C. Clinical governance
9
5%
D. Good medical practice
9
5%
Two things candidates often miss:
More than two-thirds of the paper is not "clinical care" in the narrow sense. Theme 2 is only 30%. Transfer, equipment, extrication, major incidents, governance and team working make up the rest.
About a quarter of questions involve children. The College says roughly 75% of questions relate to adults and 25% to younger patients (Review, p. 7).
DipIMC.Ninja's question bank is tagged to the same curriculum units, so you can see where your gaps are. See the curriculum.
Working at one minute a question
These are common approaches, not College advice:
Read the last line of the stem first so you know what is being asked, then read the scenario.
Answer the question asked. "Most appropriate next step" and "first priority" are different questions.
Answer to UK guidance, not local protocol. Where a textbook and a newer guideline disagree, the current national guideline usually wins, and a good question names the guideline it wants.
Don't leave blanks. Because the score is simply the number you answer correctly, a guess can't cost you marks.
Practise at time. Sixty questions in sixty minutes is a useful benchmark before the real three hours.
10 free practice questions
These ten questions come from the DipIMC.Ninja bank. Each one shows its sources in full, so you can check the answer yourself. Open a question to see the answer.
Question 1 · Trauma · Easy
Where should a pelvic binder be positioned to be effective?
ACentred over the iliac crests of the pelvis
BAt the level of the greater trochanters
CAcross both anterior superior iliac spines
DAround the waist, level with the umbilicus
EAs high on the pelvis as the clothing allows
Show answer
Answer: B
At the level of the greater trochanters
A pelvic binder is applied as circumferential compression at the level of the greater trochanters. The ABC of Prehospital Emergency Medicine states that pelvic binders need to be applied at the level of the greater trochanters, even though they may look better around the waist, and describes inserting the folded binder at the level of the greater trochanter during the first limited log-roll before tightening it with the patient supine. Placing it higher, over the iliac crests, the anterior superior iliac spines or the waist, is the classic error. Bind the knees and feet as well, to limit rotation at the hip.
Where this comes from
ABC of Prehospital Emergency Medicine
Ch. 16 Trauma: Pelvic Injury · Tips from the field · p. 86“Pelvic binders need to be applied at the level of the greater trochanters”
Ch. 16 Trauma: Pelvic Injury · Pelvic binders: application · p. 85“circumferential compression with binder at greater trochanter”
Ch. 8 Circulation Assessment and Management · Pelvic binding · p. 39“the corner inserted at the level of the greater trochanter”
Ch. 8 Circulation Assessment and Management · Pelvic binding · p. 39“It is important to ensure the feet and knees are bound”
tr-002 · Trauma · Trauma · Easy · v4
Question 2 · Trauma · Moderate
A ventilated trauma patient is to be moved by unpressurised helicopter. He has a chest drain in situ for a left haemopneumothorax, a plaster cast on the right forearm and a distended abdomen with an ileus. Which action is most important before the aircraft lifts?
AClamp the chest drain for the whole of the flight
BReduce the inspired oxygen fraction before take-off
CRemove the forearm plaster cast completely first
DPass a nasogastric tube and leave it on free drainage
EDeflate the tracheal tube cuff fully before take-off
Show answer
Answer: D
Pass a nasogastric tube and leave it on free drainage
As barometric pressure falls with altitude, gas in body cavities expands and the alveolar partial pressure of oxygen falls. The ICS/FICM transfer guidance therefore requires that nasogastric tubes are inserted and placed on free drainage, and in a patient with an ileus the gut holds the largest volume of trapped gas. Chest drains should not be clamped during transfer; underwater-seal drains are kept upright and below the patient, and clamping a drained pneumothorax at altitude invites tension. Increased inspired oxygen is mandatory for all aeromedical transfers, not a reduction. Plaster casts are split, not removed, to allow for swelling. Endotracheal tube cuff pressure is monitored, because the gas in the cuff expands too, but deflating the cuff removes airway protection. Pneumoperitoneum and intracranial air are relative contraindications to air transport for the same reason.
You are using a rectilinear biphasic defibrillator on a 95 kg man in ventricular fibrillation. The machine has come on with a default first-shock setting of 120 J. What energy should you deliver?
AFirst shock 120 J, escalating if not successful
BFirst shock ≥150 J, escalating if unsuccessful
CFirst shock 130 J, escalating if unsuccessful
DFirst shock ≥150 J, never above that energy
EFirst shock 120 J, same energy thereafter
Show answer
Answer: B
First shock ≥150 J, escalating if unsuccessful
RCUK Adult ALS 2025: for rectilinear biphasic or truncated exponential biphasic waveforms, the first shock should be at least 150 J; 130–150 J applies only to pulsed biphasic waveforms. If the first shock fails and the defibrillator can deliver more, it is reasonable to increase the energy for subsequent shocks. So a 120 J default should be increased before the first shock, whether or not later shocks escalate; 130 J borrows the pulsed-biphasic figure for the wrong device; and capping every shock at the first-shock energy rules out the escalation the guideline supports. Body weight does not change adult energy: the guideline says to use standard energy levels in obese patients, so his 95 kg is a distraction.
A general practitioner visits a 34-year-old man at home who is unwell with a possible chest infection. Which statement about applying NICE guidance on suspected sepsis to this consultation is correct?
ANG253 covers suspected sepsis at any age, including in his 4-year-old daughter
BNG253 directs the GP to calculate a NEWS2 score and act on the band it falls in
CNG51 remains the current NICE guideline for suspected sepsis in people over 16
DIn the community, NG253 grades his risk on history, examination and age criteria
ENG253 applies to pregnant and recently pregnant women exactly as to anyone else
Show answer
Answer: D
In the community, NG253 grades his risk on history, examination and age criteria
NG253 divides the ground by setting as well as by age. For people aged 16 or over in the community and in custodial settings — which includes a GP home visit — it grades the risk of severe illness or death from sepsis using the person's history, physical examination results and criteria based on age, not NEWS2; anyone meeting a high-risk criterion is referred for emergency medical care, with secondary care pre-alerted. NEWS2 is the tool in acute settings, and NG253 gives ambulance crews a NEWS2-based trigger of their own. NG253 replaces NG51. It covers people aged 16 or over: NICE has separate guidelines on suspected sepsis in people under 16 (NG254) and in pregnant or recently pregnant people (NG255), so neither the child nor a pregnant patient falls under NG253. NG254 and NG255 are not held in this project's reference set, so paediatric and maternal sepsis are not examined here.
med-077 · Medical & Resuscitation · Medical · Easy · v2
Question 5 · Major Incident & Triage · Easy
A firefighter is carrying out first-pass triage at the scene of a bus crash, before any ambulance clinician has reached the casualties. One casualty is able to walk when instructed. Under Ten Second Triage, what category is assigned?
APriority 1 (red)
BPriority 2 (amber)
CPriority 3 (green)
DPriority 4 (blue)
ENot breathing (silver)
Show answer
Answer: C
Priority 3 (green)
Walking is the first discriminator in Ten Second Triage: injured casualties who are independently mobile or can self-evacuate are categorised P3, marked with the green band, whatever the injury looks like. Note who is doing the triaging. Ten Second Triage was developed for use by all first responders to any incident with multiple casualties, non-clinical responders such as this firefighter included, which is the biggest doctrinal change from the triage sieve (a clinical tool, though it too put walking casualties into priority 3). Its only categories are red P1, amber P2, green P3 and silver Not breathing, so there is no P4 or expectant category. The ambulance on-scene commander decides when to switch from Ten Second Triage to the NHS Major Incident Triage Tool, once all casualties have been triaged and moved to a casualty collection point.
Oxford Manual of Major Incident Managementp. 24Ch. 1 An Introduction to Major Incident Management · Triage and categorization systems: triage sieve (historical)“The uninjured and ‘walking wounded’ can then be identified”
mi-003 · Major Incident & Triage · Major Incident · Easy · v5
Question 6 · Scene Safety & Extrication · Moderate
A fire service watch manager asks a HEMS doctor how common spinal cord injury actually is among people trapped in cars, since the crew's training has emphasised movement minimisation above everything else. According to the data underpinning the FPHC EXIT consensus statement on extrication, approximately what proportion of trapped patients have a spinal cord injury?
A0.7%
B3.5%
C7%
D15%
E40%
Show answer
Answer: A
0.7%
The EXIT project data that underpin the Faculty of Pre-Hospital Care's extrication consensus show that approximately 0.7% of patients trapped following a motor vehicle collision have a spinal cord injury. That low figure underpins the consensus's central shift: all patients with injury should be considered time dependent, and the extrication plan should be built around minimising entrapment time rather than absolute movement minimisation. The same work found that trapped patients are more severely injured than those not trapped (median injury severity score 18 against 13) and have higher mortality; that female patients are more likely to be trapped than males; and that older patients have an excess mortality associated with entrapment. The biomechanical study found the smallest cervical movement with self-extrication (2.6 mm) and the largest with rapid extrication (6.21 mm).
Where this comes from
Extrication following a motor vehicle collision: consensus statementRoyal College of Surgeons of Edinburgh, Faculty of Pre-Hospital Care, November 2024 (Nutbeam, Fenwick, Haldane, Leech, Foote, Todd, Lockey)·Recommendations: spinal cord injury in trapped patients“Approximately 0.7% of patients who are trapped following a MVC”Open PDF at page 9
A hypothermic casualty has impaired consciousness and has stopped shivering but has palpable vital signs. What Swiss hypothermia stage is this?
AStage I
BStage II
CStage III
DStage IV
EStage V
Show answer
Answer: B
Stage II
Resuscitation Council UK Guidelines 2025 use the Swiss Staging System when core temperature cannot be measured. Stage I (mild) is a conscious patient with shivering, estimated core temperature 35–32 °C. Stage II (moderate) is impaired consciousness, such as confusion or lethargy, with shivering decreased or absent, estimated core temperature 32–28 °C, which is this casualty. Stage III (severe) is an unconscious patient whose vital signs (pulse and breathing) are still present, estimated 28–24 °C. Stage IV (deep) is the absence of vital signs, estimated core temperature below 24 °C. The RCUK 2025 table stops at Stage IV; a fifth stage is not part of it. The distinction between II and III turns on consciousness: impaired but present is Stage II, unconscious with signs of life is Stage III.
Special circumstances guidelines 2025Resuscitation Council UK, October 2025·Accidental hypothermia: Swiss Staging System“Stage II (Moderate): Impaired consciousness (e.g. confusion, lethargy), shivering may be decreased or absent”Open at this sentence
Question 8 · Law, Ethics & Human Factors · Moderate
A 16-year-old with capacity consents to treatment that her parents oppose. Which statement is correct in England and Wales?
AHer consent is valid only once a parent with parental responsibility also agrees to it
BHer consent is as effective as an adult's under section 8 of the Family Law Reform Act 1969
CHer consent is valid only if she is also assessed as Gillick competent for this decision
DHer consent is valid only once a court has authorised treatment against her parents' wishes
EHer consent is valid only if a second clinician confirms that she has capacity to give it
Show answer
Answer: B
Her consent is as effective as an adult's under section 8 of the Family Law Reform Act 1969
Section 8(1) of the Family Law Reform Act 1969: the consent of a minor who has reached 16 to surgical, medical or dental treatment is as effective as it would be if they were of full age, and it is then not necessary to obtain consent from a parent or guardian. Her parents therefore cannot veto a valid consent, and no court order or second clinician is needed. Gillick competence is the test for children under 16, so requiring it at 16 applies the wrong test; the Mental Capacity Act's powers, by contrast, do not apply to anyone under 16 (section 2(5)), and a 16-year-old's capacity is assessed under that Act. Consent and refusal are not symmetrical: refusal by a 16- or 17-year-old can be overridden in some circumstances, and the Oxford Handbook notes that children may not refuse treatment on their own behalf against the wishes of a parent or guardian until they are 18.
Ch. 8 Child health · Consent · p. 532“a child of 16 has the capability to give informed consent”
Ch. 8 Child health · Consent · p. 532“may not refuse treatment on their own behalf against the wishes of a parent”
law-004 · Law, Ethics & Human Factors · Law & Ethics · Moderate · v4
Question 9 · Paediatrics & Obstetrics · Easy
A newborn remains bradycardic at 40 per minute despite 30 seconds of ventilation that is visibly moving the chest. You start chest compressions. What rate and ratio should you use?
A3:1, giving 90 compressions and 30 ventilations per minute
B3:1, giving 100 compressions and 33 ventilations per minute
C15:2, giving 100 to 120 compressions per minute between breaths
D5:1, giving 100 compressions and 20 ventilations per minute
E30:2, giving 100 to 120 compressions per minute between breaths
Show answer
Answer: A
3:1, giving 90 compressions and 30 ventilations per minute
Guidelines 2025 use a 3:1 synchronised compression-to-ventilation ratio, aiming for 90 compressions and 30 ventilations (120 events) per minute, with the two-thumb, hands-encircling technique compressing to a depth of one-third of the anterior-posterior chest diameter; the Oxford Handbook gives the same 3:1 ratio for newborn resuscitation. The other ratios are not the newborn ratio, and 100 compressions with 33 breaths misstates the 120-events target. Discontinue compressions once the heart rate is above 60 per minute. If the heart rate remains absent for more than 20 minutes after birth despite all recommended steps and the exclusion of reversible causes, the guideline says to consider stopping, but it also notes that in most UK out-of-hospital settings clinicians would not be expected to discontinue resuscitation.
Oxford Handbook of Pre-Hospital Carepp. 696–698Ch. 12 Emergency obstetrics, gynaecology, and care of the newborn · Neonatal resuscitation“The recommended compression:ventilation ratio is 3:1 for newborn resuscitation.”
Under the Resuscitation Council UK Guidelines 2025, what energy should be used for the first defibrillation attempt in a child in ventricular fibrillation?
A1 J/kg
B2 J/kg
C4 J/kg
D10 J/kg
EA fixed 50 J
Show answer
Answer: C
4 J/kg
Resuscitation Council UK Guidelines 2025 use 4 J/kg as the standard energy for the initial shocks, not exceeding the adult dose (120 to 200 J depending on the defibrillator). For refractory VF or pulseless VT, meaning more than five shocks are needed, the energy is increased stepwise up to 8 J/kg (maximum 360 J). The Oxford Handbook gives the same single shock of 4 J/kg with a manual defibrillator. Be aware that the ABC of Prehospital Emergency Medicine (2013) reflects older international advice, an initial 2 to 4 J/kg with later shocks up to 10 J/kg; that is why the stem names the current UK guideline. 1 J/kg is the starting dose for synchronised cardioversion of a tachycardia, not for defibrillation, and a fixed 50 J is not weight-based.
Oxford Handbook of Pre-Hospital Carep. 516Ch. 8 Child health · Paediatric life support: shockable rhythms“Give 1 shock of 4 J kg-1 if using a manual defibrillator”
ABC of Prehospital Emergency Medicinep. 123Ch. 22 Cardiac Arrest · Paediatric resuscitation“an initial shock at 2–4 joules/kg should be administered”