South Carolina
EMS/Paramedic State
Protocol: The Elite
Universal Test Bank
PART 0: THE NAVIGATOR
● Tier 1 (Questions 1–28) - Foundational Syntax & Application: Testing "Hard Deck"
definitions, core formulas, and primary SC DHEC 2025/2026 updates including formulary
additions (Keppra, Haldol, Solu-Cortef), Rocuronium dosing, and Regulation 61-7 legal
mandates.
● Tier 2 (Questions 29–58) - Complex Application & Simulation: "Situation X occurs.
Variable Y changes." Covering dynamic clinical operations including the SC RACE stroke
scale, Sepsis Alert (COG 200-501) criteria, and Major Trauma triage bypass.
● Tier 3 (Questions 59–88) - Grandmaster Synthesis: High-stakes, multi-variable
scenarios requiring the simultaneous synthesis of airway management, profound
physiological intuition, and state jurisprudential frameworks.
PART I: THE PRIMER
This document forges elite paramedics who seamlessly integrate South Carolina’s stringent
2025/2026 medical protocols into high-stakes clinical practice. By mastering this test bank, your
clinical acumen becomes an impregnable shield against liability, ensuring unparalleled patient
survival and regulatory compliance.
● The RACE Imperative: The SC RACE (Rapid Arterial oCclusion Evaluation) scale is
mandatory for suspected stroke. A score of ≥4 strongly indicates a Large Vessel
Occlusion (LVO), mandating rapid transport (scene time ≤10 mins) and early
comprehensive center notification.
● The Sepsis Trigger: A Sepsis Alert requires a suspected infection source combined with
two or more SIRS criteria (e.g., HR >90, RR >20, Temp abnormal). It mandates
aggressive fluid resuscitation (30 mL/kg) followed by targeted early antibiotics (e.g.,
Ceftriaxone 1g or Zosyn 4.5g).
● The 2025 Formulary Shift: Rocuronium dosing for RSI is rigidly set at 0.6–1.0 mg/kg.
Intravenous Nitroglycerin is newly authorized for CHF exacerbations at 1mg IV initially
(repeatable q5min to a max of 3 doses). Haldol, Keppra, and Solu-Cortef are now active
primary agents.
● The TXA Window: Tranexamic Acid (TXA) is strictly indicated for non-compressible
, hemorrhage with SBP <90 within 3 hours of injury, or postpartum hemorrhage. It requires
100% agency QA review and a specific letter of agreement from the receiving trauma
center.
● The Regulatory Baseline (Regulation 61-7): Adverse clinical incidents MUST be
reported electronically to DHEC within 72 hours, followed by a written report within 5
days. Adult ePCRs are retained for 10 years; minors for 13 years.
PART II: THE ELITE TEST BANK
Q1: An adult patient in severe Congestive Heart Failure (CHF) requires intervention under the
2025 SC EMS Clinical Operating Guidelines. Which action regarding Nitroglycerin is the MOST
APPROPRIATE? A) Administer 0.4mg sublingually every 5 minutes until relief is achieved. B)
Initiate a continuous IV infusion at 10 mcg/min. C) Administer a 1mg IV bolus, repeatable every
5 minutes up to three doses. D) Administer 2mg IV push immediately.
● The Answer: C (Administer a 1mg IV bolus, repeatable every 5 minutes up to three
doses.)
● Distractor Analysis:
○ A is incorrect: While sublingual is a legacy standard for angina, the 2025 SC CHF
protocol specifically authorizes IV NTG for rapid, aggressive preload reduction.
○ B is incorrect: Infusions are reserved for interfacility transfers; the initial prehospital
protocol calls for a bolus.
○ D is incorrect: 2mg exceeds the mandated 1mg initial dose parameter.
The Mentor's Analysis: The 2025 update fundamentally shifts cardiogenic pulmonary edema
management. When facing acute CHF, the immediate priority is aggressive fluid redistribution.
By utilizing a 1mg Intravenous Nitroglycerin bolus, you bypass the common trap of delayed
sublingual absorption. Professional/Academic Intuition: Aggressive, precise preload
reduction via IV NTG is the vanguard of CHF crisis management.
Q2: During Rapid Sequence Intubation (RSI) preparation, the paramedic selects Rocuronium for
paralysis. According to the updated 2025 SC Formulary, which dosing range is
UNEQUIVOCALLY correct? A) 1.0–1.5 mg/kg B) 0.1–0.3 mg/kg C) 0.6–1.0 mg/kg D) 2.0 mg/kg
● The Answer: C (0.6–1.0 mg/kg)
● Distractor Analysis:
○ A is incorrect: This is an outdated legacy standard that has been actively revised
down in South Carolina.
○ B is incorrect: This is the dosing range for Vecuronium or Etomidate, not
Rocuronium.
○ D is incorrect: This represents a massive overdose that will indefinitely prolong
paralysis without offering superior intubating conditions.
The Mentor's Analysis: Muscle relaxation parameters have been strictly defined to balance
optimal intubating conditions with patient safety. When facing RSI, the immediate priority is
securing the airway without inducing prolonged, unmanageable apnea. By utilizing the 0.6-1.0
mg/kg window, you bypass the common trap of excessive neuromuscular blockade.
Professional/Academic Intuition: Mastery of the 0.6-1.0 mg/kg Rocuronium window prevents
catastrophic, unrecoverable airway delays.
Q3: An agency experiences an adverse incident where a patient is dropped from a stretcher,
sustaining a laceration. Under SC Regulation 61-7, what is the FIRST mandatory reporting
timeline? A) Written report within 5 calendar days. B) Verbal notification to Medical Control
,within 24 hours. C) Electronic incident report to the Department within 72 hours. D) Inclusion in
the quarterly QA aggregate report.
● The Answer: C (Electronic incident report to the Department within 72 hours.)
● Distractor Analysis:
○ A is incorrect: The written investigation report is due within 5 days after the initial
electronic report is filed. * B is incorrect: Verbal notification is clinical, not the official
state regulatory mandate for this tier of incident. * D is incorrect: Waiting for a
quarterly report constitutes a severe regulatory violation and obstruction.
The Mentor's Analysis: State regulators demand rapid, electronic visibility on adverse events.
When facing an operational failure, the immediate priority is transparent reporting. By utilizing
the 72-hour electronic portal, you bypass the common trap of regulatory non-compliance.
Professional/Academic Intuition: The 72-hour electronic report is a non-negotiable legal
hard deck.
Q4: A paramedic is assessing a suspected stroke patient using the SC RACE tool. The patient
cannot raise their arm against gravity. Which score for "Arm Motor Function" is the MOST
ACCURATE? A) 0 B) 1 C) 2 D) 4
● The Answer: C (2)
● Distractor Analysis:
○ A is incorrect: 0 indicates normal function where the limb is upheld for more than 10
seconds.
○ B is incorrect: 1 indicates moderate impairment where the limb is upheld for less
than 10 seconds but can still fight gravity.
○ D is incorrect: The motor function sub-score maxes out at 2, not 4.
The Mentor's Analysis: The RACE scale stratifies severity surgically to identify large vessel
occlusions. When facing focal deficits, the immediate priority is exact quantification. By utilizing
the max score of 2 for gravity failure, you bypass the common trap of over-calculating
sub-metrics. Professional/Academic Intuition: Inability to overcome gravity represents the
absolute maximum deficit for a specific limb on the RACE scale.
Q5: A patient with a known seizure disorder is actively seizing despite the maximum authorized
administration of benzodiazepines. Under the 2025 SC EMS Formulary additions, which
medication is newly approved for refractory seizures? A) Phenytoin B) Propofol C)
Levetiracetam (Keppra) D) Magnesium Sulfate
● The Answer: C (Levetiracetam (Keppra))
● Distractor Analysis:
○ A is incorrect: Phenytoin is not typically carried on SC EMS units for primary
prehospital response.
○ B is incorrect: Propofol is restricted to RSI/sedation maintenance, not primary
anti-epileptic therapy.
○ D is incorrect: Magnesium is reserved for eclamptic seizures or Torsades de
Pointes.
The Mentor's Analysis: Status epilepticus destroys neurons rapidly. When facing
benzodiazepine-refractory seizures, the immediate priority is secondary pathway termination. By
utilizing Levetiracetam, you bypass the common trap of stacking lethal doses of GABA-agonists.
Professional/Academic Intuition: When benzos fail, Keppra provides targeted, non-sedating
seizure termination.
Q6: You arrive on the scene of a traumatic amputation. The patient exhibits a systolic BP of 85
mmHg. The incident occurred 45 minutes ago. Which intervention MUST be cleared by a
primary receiving trauma center letter of agreement prior to agency implementation? A)
, Tourniquet application B) Fluid resuscitation with Lactated Ringers C) Tranexamic Acid (TXA)
administration D) Fentanyl administration
● The Answer: C (Tranexamic Acid (TXA) administration)
● Distractor Analysis:
○ A is incorrect: Tourniquets are BLS/ALS baseline skills requiring no specific facility
letter.
○ B is incorrect: Isotonic fluids are standard standing orders.
○ D is incorrect: Analgesia is a standard standing order.
The Mentor's Analysis: TXA carries massive systemic implications and requires absolute
hospital continuity (the 8-hour secondary infusion). When facing non-compressible hemorrhage,
the immediate priority is fibrinolysis inhibition. By utilizing pre-authorized TXA protocols, you
bypass the common trap of fragmented care. Professional/Academic Intuition: Prehospital TXA
is a systemic contract requiring 100% QA, not an isolated field intervention.
Q7: You are treating a severely agitated, combative patient who requires immediate chemical
restraint to prevent self-harm. According to the updated formulary, which antipsychotic is newly
approved and available for this indication? A) Droperidol B) Ziprasidone C) Haldol (Haloperidol)
D) Olanzapine
● The Answer: C (Haldol (Haloperidol))
● Distractor Analysis:
○ A is incorrect: Droperidol may be used in other states, but Haldol is the specific
2025 SC addition.
○ B is incorrect: Ziprasidone is not on the primary SC prehospital formulary.
○ D is incorrect: Olanzapine is an ODT option in some protocols, but Haldol is the
primary injectable addition.
The Mentor's Analysis: Managing extreme agitation requires reliable, rapid intramuscular
agents. When facing dangerous combativeness, the immediate priority is safe chemical
restraint. By utilizing Haloperidol, you bypass the common trap of relying solely on
respiratory-depressing benzodiazepines. Professional/Academic Intuition: Haldol provides
decisive chemical restraint when verbal de-escalation fails.
Q8: A paramedic is recertifying their credential. According to the NCCP model and SC DPH
Form 2353A, how many total hours of continuing education are REQUIRED? A) 40 hours B) 48
hours C) 60 hours D) 72 hours
● The Answer: C (60 hours)
● Distractor Analysis:
○ A is incorrect: 40 hours is the standard for EMT-Basic.
○ B is incorrect: 48 hours is an outdated legacy registry standard.
○ D is incorrect: 72 hours exceeds the current NCCP paramedic mandate.
The Mentor's Analysis: The 60-hour NCCP model perfectly divides into National (30), State (15),
and Local (15) requirements. When facing recertification, the immediate priority is precise hour
allocation. By utilizing the DPH 2353A framework, you bypass the common trap of lapsed
licensure. Professional/Academic Intuition: Regulatory compliance is a strict mathematical
formula; Paramedics demand exactly 60 hours.
Q9: A paramedic is treating a pediatric patient in cardiac arrest. According to the SC Clinical
Operating Guidelines, what is the CORRECT dose of intravenous Epinephrine (0.1 mg/mL
concentration)? A) 0.01 mg/kg B) 0.1 mg/kg C) 1 mg total D) 0.15 mg total
● The Answer: A (0.01 mg/kg)
● Distractor Analysis:
○ B is incorrect: 0.1 mg/kg is the dose for endotracheal administration, not IV.
EMS/Paramedic State
Protocol: The Elite
Universal Test Bank
PART 0: THE NAVIGATOR
● Tier 1 (Questions 1–28) - Foundational Syntax & Application: Testing "Hard Deck"
definitions, core formulas, and primary SC DHEC 2025/2026 updates including formulary
additions (Keppra, Haldol, Solu-Cortef), Rocuronium dosing, and Regulation 61-7 legal
mandates.
● Tier 2 (Questions 29–58) - Complex Application & Simulation: "Situation X occurs.
Variable Y changes." Covering dynamic clinical operations including the SC RACE stroke
scale, Sepsis Alert (COG 200-501) criteria, and Major Trauma triage bypass.
● Tier 3 (Questions 59–88) - Grandmaster Synthesis: High-stakes, multi-variable
scenarios requiring the simultaneous synthesis of airway management, profound
physiological intuition, and state jurisprudential frameworks.
PART I: THE PRIMER
This document forges elite paramedics who seamlessly integrate South Carolina’s stringent
2025/2026 medical protocols into high-stakes clinical practice. By mastering this test bank, your
clinical acumen becomes an impregnable shield against liability, ensuring unparalleled patient
survival and regulatory compliance.
● The RACE Imperative: The SC RACE (Rapid Arterial oCclusion Evaluation) scale is
mandatory for suspected stroke. A score of ≥4 strongly indicates a Large Vessel
Occlusion (LVO), mandating rapid transport (scene time ≤10 mins) and early
comprehensive center notification.
● The Sepsis Trigger: A Sepsis Alert requires a suspected infection source combined with
two or more SIRS criteria (e.g., HR >90, RR >20, Temp abnormal). It mandates
aggressive fluid resuscitation (30 mL/kg) followed by targeted early antibiotics (e.g.,
Ceftriaxone 1g or Zosyn 4.5g).
● The 2025 Formulary Shift: Rocuronium dosing for RSI is rigidly set at 0.6–1.0 mg/kg.
Intravenous Nitroglycerin is newly authorized for CHF exacerbations at 1mg IV initially
(repeatable q5min to a max of 3 doses). Haldol, Keppra, and Solu-Cortef are now active
primary agents.
● The TXA Window: Tranexamic Acid (TXA) is strictly indicated for non-compressible
, hemorrhage with SBP <90 within 3 hours of injury, or postpartum hemorrhage. It requires
100% agency QA review and a specific letter of agreement from the receiving trauma
center.
● The Regulatory Baseline (Regulation 61-7): Adverse clinical incidents MUST be
reported electronically to DHEC within 72 hours, followed by a written report within 5
days. Adult ePCRs are retained for 10 years; minors for 13 years.
PART II: THE ELITE TEST BANK
Q1: An adult patient in severe Congestive Heart Failure (CHF) requires intervention under the
2025 SC EMS Clinical Operating Guidelines. Which action regarding Nitroglycerin is the MOST
APPROPRIATE? A) Administer 0.4mg sublingually every 5 minutes until relief is achieved. B)
Initiate a continuous IV infusion at 10 mcg/min. C) Administer a 1mg IV bolus, repeatable every
5 minutes up to three doses. D) Administer 2mg IV push immediately.
● The Answer: C (Administer a 1mg IV bolus, repeatable every 5 minutes up to three
doses.)
● Distractor Analysis:
○ A is incorrect: While sublingual is a legacy standard for angina, the 2025 SC CHF
protocol specifically authorizes IV NTG for rapid, aggressive preload reduction.
○ B is incorrect: Infusions are reserved for interfacility transfers; the initial prehospital
protocol calls for a bolus.
○ D is incorrect: 2mg exceeds the mandated 1mg initial dose parameter.
The Mentor's Analysis: The 2025 update fundamentally shifts cardiogenic pulmonary edema
management. When facing acute CHF, the immediate priority is aggressive fluid redistribution.
By utilizing a 1mg Intravenous Nitroglycerin bolus, you bypass the common trap of delayed
sublingual absorption. Professional/Academic Intuition: Aggressive, precise preload
reduction via IV NTG is the vanguard of CHF crisis management.
Q2: During Rapid Sequence Intubation (RSI) preparation, the paramedic selects Rocuronium for
paralysis. According to the updated 2025 SC Formulary, which dosing range is
UNEQUIVOCALLY correct? A) 1.0–1.5 mg/kg B) 0.1–0.3 mg/kg C) 0.6–1.0 mg/kg D) 2.0 mg/kg
● The Answer: C (0.6–1.0 mg/kg)
● Distractor Analysis:
○ A is incorrect: This is an outdated legacy standard that has been actively revised
down in South Carolina.
○ B is incorrect: This is the dosing range for Vecuronium or Etomidate, not
Rocuronium.
○ D is incorrect: This represents a massive overdose that will indefinitely prolong
paralysis without offering superior intubating conditions.
The Mentor's Analysis: Muscle relaxation parameters have been strictly defined to balance
optimal intubating conditions with patient safety. When facing RSI, the immediate priority is
securing the airway without inducing prolonged, unmanageable apnea. By utilizing the 0.6-1.0
mg/kg window, you bypass the common trap of excessive neuromuscular blockade.
Professional/Academic Intuition: Mastery of the 0.6-1.0 mg/kg Rocuronium window prevents
catastrophic, unrecoverable airway delays.
Q3: An agency experiences an adverse incident where a patient is dropped from a stretcher,
sustaining a laceration. Under SC Regulation 61-7, what is the FIRST mandatory reporting
timeline? A) Written report within 5 calendar days. B) Verbal notification to Medical Control
,within 24 hours. C) Electronic incident report to the Department within 72 hours. D) Inclusion in
the quarterly QA aggregate report.
● The Answer: C (Electronic incident report to the Department within 72 hours.)
● Distractor Analysis:
○ A is incorrect: The written investigation report is due within 5 days after the initial
electronic report is filed. * B is incorrect: Verbal notification is clinical, not the official
state regulatory mandate for this tier of incident. * D is incorrect: Waiting for a
quarterly report constitutes a severe regulatory violation and obstruction.
The Mentor's Analysis: State regulators demand rapid, electronic visibility on adverse events.
When facing an operational failure, the immediate priority is transparent reporting. By utilizing
the 72-hour electronic portal, you bypass the common trap of regulatory non-compliance.
Professional/Academic Intuition: The 72-hour electronic report is a non-negotiable legal
hard deck.
Q4: A paramedic is assessing a suspected stroke patient using the SC RACE tool. The patient
cannot raise their arm against gravity. Which score for "Arm Motor Function" is the MOST
ACCURATE? A) 0 B) 1 C) 2 D) 4
● The Answer: C (2)
● Distractor Analysis:
○ A is incorrect: 0 indicates normal function where the limb is upheld for more than 10
seconds.
○ B is incorrect: 1 indicates moderate impairment where the limb is upheld for less
than 10 seconds but can still fight gravity.
○ D is incorrect: The motor function sub-score maxes out at 2, not 4.
The Mentor's Analysis: The RACE scale stratifies severity surgically to identify large vessel
occlusions. When facing focal deficits, the immediate priority is exact quantification. By utilizing
the max score of 2 for gravity failure, you bypass the common trap of over-calculating
sub-metrics. Professional/Academic Intuition: Inability to overcome gravity represents the
absolute maximum deficit for a specific limb on the RACE scale.
Q5: A patient with a known seizure disorder is actively seizing despite the maximum authorized
administration of benzodiazepines. Under the 2025 SC EMS Formulary additions, which
medication is newly approved for refractory seizures? A) Phenytoin B) Propofol C)
Levetiracetam (Keppra) D) Magnesium Sulfate
● The Answer: C (Levetiracetam (Keppra))
● Distractor Analysis:
○ A is incorrect: Phenytoin is not typically carried on SC EMS units for primary
prehospital response.
○ B is incorrect: Propofol is restricted to RSI/sedation maintenance, not primary
anti-epileptic therapy.
○ D is incorrect: Magnesium is reserved for eclamptic seizures or Torsades de
Pointes.
The Mentor's Analysis: Status epilepticus destroys neurons rapidly. When facing
benzodiazepine-refractory seizures, the immediate priority is secondary pathway termination. By
utilizing Levetiracetam, you bypass the common trap of stacking lethal doses of GABA-agonists.
Professional/Academic Intuition: When benzos fail, Keppra provides targeted, non-sedating
seizure termination.
Q6: You arrive on the scene of a traumatic amputation. The patient exhibits a systolic BP of 85
mmHg. The incident occurred 45 minutes ago. Which intervention MUST be cleared by a
primary receiving trauma center letter of agreement prior to agency implementation? A)
, Tourniquet application B) Fluid resuscitation with Lactated Ringers C) Tranexamic Acid (TXA)
administration D) Fentanyl administration
● The Answer: C (Tranexamic Acid (TXA) administration)
● Distractor Analysis:
○ A is incorrect: Tourniquets are BLS/ALS baseline skills requiring no specific facility
letter.
○ B is incorrect: Isotonic fluids are standard standing orders.
○ D is incorrect: Analgesia is a standard standing order.
The Mentor's Analysis: TXA carries massive systemic implications and requires absolute
hospital continuity (the 8-hour secondary infusion). When facing non-compressible hemorrhage,
the immediate priority is fibrinolysis inhibition. By utilizing pre-authorized TXA protocols, you
bypass the common trap of fragmented care. Professional/Academic Intuition: Prehospital TXA
is a systemic contract requiring 100% QA, not an isolated field intervention.
Q7: You are treating a severely agitated, combative patient who requires immediate chemical
restraint to prevent self-harm. According to the updated formulary, which antipsychotic is newly
approved and available for this indication? A) Droperidol B) Ziprasidone C) Haldol (Haloperidol)
D) Olanzapine
● The Answer: C (Haldol (Haloperidol))
● Distractor Analysis:
○ A is incorrect: Droperidol may be used in other states, but Haldol is the specific
2025 SC addition.
○ B is incorrect: Ziprasidone is not on the primary SC prehospital formulary.
○ D is incorrect: Olanzapine is an ODT option in some protocols, but Haldol is the
primary injectable addition.
The Mentor's Analysis: Managing extreme agitation requires reliable, rapid intramuscular
agents. When facing dangerous combativeness, the immediate priority is safe chemical
restraint. By utilizing Haloperidol, you bypass the common trap of relying solely on
respiratory-depressing benzodiazepines. Professional/Academic Intuition: Haldol provides
decisive chemical restraint when verbal de-escalation fails.
Q8: A paramedic is recertifying their credential. According to the NCCP model and SC DPH
Form 2353A, how many total hours of continuing education are REQUIRED? A) 40 hours B) 48
hours C) 60 hours D) 72 hours
● The Answer: C (60 hours)
● Distractor Analysis:
○ A is incorrect: 40 hours is the standard for EMT-Basic.
○ B is incorrect: 48 hours is an outdated legacy registry standard.
○ D is incorrect: 72 hours exceeds the current NCCP paramedic mandate.
The Mentor's Analysis: The 60-hour NCCP model perfectly divides into National (30), State (15),
and Local (15) requirements. When facing recertification, the immediate priority is precise hour
allocation. By utilizing the DPH 2353A framework, you bypass the common trap of lapsed
licensure. Professional/Academic Intuition: Regulatory compliance is a strict mathematical
formula; Paramedics demand exactly 60 hours.
Q9: A paramedic is treating a pediatric patient in cardiac arrest. According to the SC Clinical
Operating Guidelines, what is the CORRECT dose of intravenous Epinephrine (0.1 mg/mL
concentration)? A) 0.01 mg/kg B) 0.1 mg/kg C) 1 mg total D) 0.15 mg total
● The Answer: A (0.01 mg/kg)
● Distractor Analysis:
○ B is incorrect: 0.1 mg/kg is the dose for endotracheal administration, not IV.
