Utah EMS/Paramedic State
Protocol Exam: Elite Universal
Test Bank
PART 0: THE NAVIGATOR
● Tier 1 (Questions 1–28) - Foundational Syntax & Application: Core physiological limits,
hard-deck medication doses, and primary triage algorithms.
● Tier 2 (Questions 29–58) - Complex Application & Simulation: Dynamic patient
deterioration, FSED bypass protocols, and multi-step pharmacological interventions.
● Tier 3 (Questions 59–88) - Grandmaster Synthesis: High-stakes ethical termination,
ECMO-avalanche routing, and multi-system trauma cascade management.
PART I: THE PRIMER
Mastery of this assessment forged within the 2025/2026 Utah EMS parameters translates
directly to reduced prehospital mortality and flawless clinical execution. This document
weaponizes academic precision into instinctive, life-saving field interventions.
● The Hemodynamic Hard Deck: Pediatric hypotension is calculated strictly as: <1 month
(60 mmHg), 1 month–1 year (70 mmHg), 1–10 years (70 + [2 × age] mmHg), >10 years
(90 mmHg).
● The Triage Imperative: Patients meeting Red or Yellow trauma criteria, or experiencing
trauma arrest, must immediately bypass Freestanding Emergency Departments (FSED)
for a state-certified trauma center.
● The Airway/Ventilation Law: Target SpO2 is rigorously maintained at 90–94%, with
ETCO2 strictly held at 35–45 mmHg to prevent hyperoxic and hypocapnic brain injury.
● The Avalanche ECMO Pivot: Avalanche victims with a burial time greater than 60
minutes and a patent airway at extraction mandate direct transport to an ECMO facility.
● The De-Resuscitation Paradigm: Adult cardiac arrest resuscitative efforts may be
terminated on scene only after 20 minutes of ACLS if the arrest is unwitnessed, no
shockable rhythm was ever identified, and no ROSC occurred.
PART II: THE ELITE TEST BANK
Q1: An 8-year-old male is evaluated for hemorrhagic shock. Based on the 2025 Utah EMS
Protocol, what is the LOWEST acceptable systolic blood pressure (SBP)? A) 70 mmHg B) 86
mmHg C) 90 mmHg D) 100 mmHg
● The Answer: B (86 mmHg)
● Distractor Analysis:
, ○ A is incorrect: 70 mmHg is the baseline without the age multiplier.
○ C is incorrect: 90 mmHg is the threshold strictly for patients over 10 years old.
○ D is incorrect: 100 mmHg is an arbitrary adult metric inapplicable to pediatrics.
The Mentor's Analysis: Pediatric compensation masks shock until cardiovascular collapse is
imminent. By utilizing the 70 + (2 × age) formula, you bypass the trap of false stability.
Professional Intuition: Always calculate the pediatric hard deck before administering fluid
boluses.
Q2: A patient meets Red Trauma Criteria. The closest facility is an FSED 2 minutes away, while
a Trauma Center is 15 minutes away. What is the IMMEDIATE transport decision? A) Stop at
the FSED for physician stabilization. B) Contact OLMC to request an FSED stop. C) Bypass the
FSED and transport to the Trauma Center. D) Transport to the FSED because it is within 5
minutes.
● The Answer: C (Bypass the FSED and transport to the Trauma Center.)
● Distractor Analysis:
○ A is incorrect: FSEDs lack surgical resources required for Red Criteria trauma.
○ B is incorrect: OLMC contact is unnecessary; bypass is a standing protocol.
○ D is incorrect: Geographic proximity does not supersede surgical capability.
The Mentor's Analysis: Exsanguinating trauma requires a surgeon, not just a physician. By
utilizing the bypass protocol, you bypass the common trap of geographical convenience.
Professional Intuition: Time to the scalpel supersedes time to the door.
Q3: A paramedic manages a patient with impending respiratory failure. What is the STRICT
oxygenation target parameter? A) SpO2 100% B) SpO2 90-94% C) SpO2 >85% D) SpO2
95-99%
● The Answer: B (SpO2 90-94%)
● Distractor Analysis:
○ A is incorrect: 100% SpO2 induces hyperoxic free-radical tissue damage.
○ C is incorrect: 85% represents clinically dangerous hypoxia.
○ D is incorrect: This exceeds the strict 2025 normoxia target protocol.
The Mentor's Analysis: The era of aggressive hyperoxia is over. By utilizing targeted normoxia,
you bypass the common trap of oxygen-induced reperfusion injury. Professional Intuition:
Titrate oxygen like a vasopressor; 94% is the absolute ceiling.
Q4: An adult in ventricular fibrillation requires an antiarrhythmic after the third shock. What is the
FIRST pharmacological intervention? A) Amiodarone 300 mg IV push B) Lidocaine 3 mg/kg IV
push C) Magnesium Sulfate 2g IV push D) Calcium Chloride 1g IV push
● The Answer: A (Amiodarone 300 mg IV push)
● Distractor Analysis:
○ B is incorrect: 3 mg/kg is the maximum total dose, not the initial bolus.
○ C is incorrect: Magnesium is reserved for polymorphic VT (Torsades).
○ D is incorrect: Calcium is indicated for hyperkalemia, not primary VF.
The Mentor's Analysis: Refractory VF requires immediate membrane stabilization. By utilizing
Amiodarone first, you bypass the common trap of ineffective continuous defibrillation.
Professional Intuition: Electricity resets the rhythm; Amiodarone secures it.
Q5: An avalanche victim is extricated after 75 minutes. The airway is patent, but the patient is
pulseless (core temp 26°C). What is the MOST APPROPRIATE destination? A) Local
community hospital B) FSED C) ECMO-capable facility D) County morgue
● The Answer: C (ECMO-capable facility)
● Distractor Analysis:
○ A is incorrect: Community hospitals lack cardiopulmonary bypass rewarming.
, ○ B is incorrect: Arrested avalanche victims must bypass FSEDs.
○ D is incorrect: Resuscitation continues until the core reaches 30°C.
The Mentor's Analysis: A patent airway under snow means the arrest was thermal, not hypoxic.
By utilizing ECMO routing, you bypass the common trap of futile external rewarming.
Professional Intuition: Nobody is dead until they are warm and dead.
Q6: An adult patient in septic shock requires an Epinephrine infusion. What is the CORRECT
dosing parameter? A) 1 mg of 1:10,000 IV push every 3 min B) 0.05–1 mcg/kg/min IV/IO C)
0.1–0.5 mg/kg/min IV/IO D) 2g over 10 minutes
● The Answer: B (0.05–1 mcg/kg/min IV/IO)
● Distractor Analysis:
○ A is incorrect: This is the lethal cardiac arrest bolus dose.
○ C is incorrect: Milligram-based infusions cause catastrophic hypertensive crisis.
○ D is incorrect: This is the TXA dosage for hemorrhage.
The Mentor's Analysis: Vasopressor drips require precise weight-based micro-titration. By
utilizing microgram dosing, you bypass the common trap of massive alpha-receptor overload.
Professional Intuition: Pressors are dialed in micrograms; boluses are pushed in
milligrams.
Q7: A 6-month-old infant is in respiratory distress. What is the PREFERRED method of assisted
ventilation? A) Endotracheal intubation B) Supraglottic airway device C) Bag-Valve-Mask (BVM)
at 25 breaths/min D) CPAP at 10 cmH2O
● The Answer: C (Bag-Valve-Mask (BVM) at 25 breaths/min)
● Distractor Analysis:
○ A is incorrect: ETT is reserved only if BVM completely fails.
○ B is incorrect: SGAs are secondary rescue airways for pediatrics.
○ D is incorrect: CPAP is for awake adults, not failing infants.
The Mentor's Analysis: Pediatric airways are anatomically forgiving to BVM but highly prone to
iatrogenic trauma during intubation. By utilizing proper BVM technique, you bypass the trap of
procedural hypoxia. Professional Intuition: Master the bag before reaching for the blade.
Q8: A paramedic uses Ketamine for chemical restraint of a patient in a Psychomotor Agitated
State. What is the CORRECT adult dose? A) 40 mg diluted in 100mL NS B) 1.5 mg/kg IV push
C) 4 mg/kg IM once D) 0.15 mg/kg diluted in 100mL NS
● The Answer: C (4 mg/kg IM once)
● Distractor Analysis:
○ A is incorrect: This is the sub-dissociative analgesic dose.
○ B is incorrect: This is a legacy RSI induction dose.
○ D is incorrect: This is the pediatric analgesic dose.
The Mentor's Analysis: Severe agitation requires immediate dissociation to prevent fatal
exertion. By utilizing the 4 mg/kg IM dose, you bypass the trap of sub-therapeutic sedation.
Professional Intuition: Agitation requires dissociation; pain requires analgesia.
Q9: An adult cardiac arrest patient has suspected hyperkalemia from missed dialysis. What is
the CORRECT dose of Calcium Chloride? A) 3g IV/IO rapid push B) 1g IV/IO over 2 minutes C)
20 mg/kg IV/IO over 5 minutes D) 1 mEq/kg IV/IO
● The Answer: B (1g IV/IO over 2 minutes)
● Distractor Analysis:
○ A is incorrect: 3g is the dose for Calcium Gluconate.
○ C is incorrect: 20 mg/kg is the pediatric Calcium Chloride dose.
○ D is incorrect: 1 mEq/kg is the Sodium Bicarbonate dose.
The Mentor's Analysis: Calcium rapidly stabilizes the myocardium against lethal potassium
Protocol Exam: Elite Universal
Test Bank
PART 0: THE NAVIGATOR
● Tier 1 (Questions 1–28) - Foundational Syntax & Application: Core physiological limits,
hard-deck medication doses, and primary triage algorithms.
● Tier 2 (Questions 29–58) - Complex Application & Simulation: Dynamic patient
deterioration, FSED bypass protocols, and multi-step pharmacological interventions.
● Tier 3 (Questions 59–88) - Grandmaster Synthesis: High-stakes ethical termination,
ECMO-avalanche routing, and multi-system trauma cascade management.
PART I: THE PRIMER
Mastery of this assessment forged within the 2025/2026 Utah EMS parameters translates
directly to reduced prehospital mortality and flawless clinical execution. This document
weaponizes academic precision into instinctive, life-saving field interventions.
● The Hemodynamic Hard Deck: Pediatric hypotension is calculated strictly as: <1 month
(60 mmHg), 1 month–1 year (70 mmHg), 1–10 years (70 + [2 × age] mmHg), >10 years
(90 mmHg).
● The Triage Imperative: Patients meeting Red or Yellow trauma criteria, or experiencing
trauma arrest, must immediately bypass Freestanding Emergency Departments (FSED)
for a state-certified trauma center.
● The Airway/Ventilation Law: Target SpO2 is rigorously maintained at 90–94%, with
ETCO2 strictly held at 35–45 mmHg to prevent hyperoxic and hypocapnic brain injury.
● The Avalanche ECMO Pivot: Avalanche victims with a burial time greater than 60
minutes and a patent airway at extraction mandate direct transport to an ECMO facility.
● The De-Resuscitation Paradigm: Adult cardiac arrest resuscitative efforts may be
terminated on scene only after 20 minutes of ACLS if the arrest is unwitnessed, no
shockable rhythm was ever identified, and no ROSC occurred.
PART II: THE ELITE TEST BANK
Q1: An 8-year-old male is evaluated for hemorrhagic shock. Based on the 2025 Utah EMS
Protocol, what is the LOWEST acceptable systolic blood pressure (SBP)? A) 70 mmHg B) 86
mmHg C) 90 mmHg D) 100 mmHg
● The Answer: B (86 mmHg)
● Distractor Analysis:
, ○ A is incorrect: 70 mmHg is the baseline without the age multiplier.
○ C is incorrect: 90 mmHg is the threshold strictly for patients over 10 years old.
○ D is incorrect: 100 mmHg is an arbitrary adult metric inapplicable to pediatrics.
The Mentor's Analysis: Pediatric compensation masks shock until cardiovascular collapse is
imminent. By utilizing the 70 + (2 × age) formula, you bypass the trap of false stability.
Professional Intuition: Always calculate the pediatric hard deck before administering fluid
boluses.
Q2: A patient meets Red Trauma Criteria. The closest facility is an FSED 2 minutes away, while
a Trauma Center is 15 minutes away. What is the IMMEDIATE transport decision? A) Stop at
the FSED for physician stabilization. B) Contact OLMC to request an FSED stop. C) Bypass the
FSED and transport to the Trauma Center. D) Transport to the FSED because it is within 5
minutes.
● The Answer: C (Bypass the FSED and transport to the Trauma Center.)
● Distractor Analysis:
○ A is incorrect: FSEDs lack surgical resources required for Red Criteria trauma.
○ B is incorrect: OLMC contact is unnecessary; bypass is a standing protocol.
○ D is incorrect: Geographic proximity does not supersede surgical capability.
The Mentor's Analysis: Exsanguinating trauma requires a surgeon, not just a physician. By
utilizing the bypass protocol, you bypass the common trap of geographical convenience.
Professional Intuition: Time to the scalpel supersedes time to the door.
Q3: A paramedic manages a patient with impending respiratory failure. What is the STRICT
oxygenation target parameter? A) SpO2 100% B) SpO2 90-94% C) SpO2 >85% D) SpO2
95-99%
● The Answer: B (SpO2 90-94%)
● Distractor Analysis:
○ A is incorrect: 100% SpO2 induces hyperoxic free-radical tissue damage.
○ C is incorrect: 85% represents clinically dangerous hypoxia.
○ D is incorrect: This exceeds the strict 2025 normoxia target protocol.
The Mentor's Analysis: The era of aggressive hyperoxia is over. By utilizing targeted normoxia,
you bypass the common trap of oxygen-induced reperfusion injury. Professional Intuition:
Titrate oxygen like a vasopressor; 94% is the absolute ceiling.
Q4: An adult in ventricular fibrillation requires an antiarrhythmic after the third shock. What is the
FIRST pharmacological intervention? A) Amiodarone 300 mg IV push B) Lidocaine 3 mg/kg IV
push C) Magnesium Sulfate 2g IV push D) Calcium Chloride 1g IV push
● The Answer: A (Amiodarone 300 mg IV push)
● Distractor Analysis:
○ B is incorrect: 3 mg/kg is the maximum total dose, not the initial bolus.
○ C is incorrect: Magnesium is reserved for polymorphic VT (Torsades).
○ D is incorrect: Calcium is indicated for hyperkalemia, not primary VF.
The Mentor's Analysis: Refractory VF requires immediate membrane stabilization. By utilizing
Amiodarone first, you bypass the common trap of ineffective continuous defibrillation.
Professional Intuition: Electricity resets the rhythm; Amiodarone secures it.
Q5: An avalanche victim is extricated after 75 minutes. The airway is patent, but the patient is
pulseless (core temp 26°C). What is the MOST APPROPRIATE destination? A) Local
community hospital B) FSED C) ECMO-capable facility D) County morgue
● The Answer: C (ECMO-capable facility)
● Distractor Analysis:
○ A is incorrect: Community hospitals lack cardiopulmonary bypass rewarming.
, ○ B is incorrect: Arrested avalanche victims must bypass FSEDs.
○ D is incorrect: Resuscitation continues until the core reaches 30°C.
The Mentor's Analysis: A patent airway under snow means the arrest was thermal, not hypoxic.
By utilizing ECMO routing, you bypass the common trap of futile external rewarming.
Professional Intuition: Nobody is dead until they are warm and dead.
Q6: An adult patient in septic shock requires an Epinephrine infusion. What is the CORRECT
dosing parameter? A) 1 mg of 1:10,000 IV push every 3 min B) 0.05–1 mcg/kg/min IV/IO C)
0.1–0.5 mg/kg/min IV/IO D) 2g over 10 minutes
● The Answer: B (0.05–1 mcg/kg/min IV/IO)
● Distractor Analysis:
○ A is incorrect: This is the lethal cardiac arrest bolus dose.
○ C is incorrect: Milligram-based infusions cause catastrophic hypertensive crisis.
○ D is incorrect: This is the TXA dosage for hemorrhage.
The Mentor's Analysis: Vasopressor drips require precise weight-based micro-titration. By
utilizing microgram dosing, you bypass the common trap of massive alpha-receptor overload.
Professional Intuition: Pressors are dialed in micrograms; boluses are pushed in
milligrams.
Q7: A 6-month-old infant is in respiratory distress. What is the PREFERRED method of assisted
ventilation? A) Endotracheal intubation B) Supraglottic airway device C) Bag-Valve-Mask (BVM)
at 25 breaths/min D) CPAP at 10 cmH2O
● The Answer: C (Bag-Valve-Mask (BVM) at 25 breaths/min)
● Distractor Analysis:
○ A is incorrect: ETT is reserved only if BVM completely fails.
○ B is incorrect: SGAs are secondary rescue airways for pediatrics.
○ D is incorrect: CPAP is for awake adults, not failing infants.
The Mentor's Analysis: Pediatric airways are anatomically forgiving to BVM but highly prone to
iatrogenic trauma during intubation. By utilizing proper BVM technique, you bypass the trap of
procedural hypoxia. Professional Intuition: Master the bag before reaching for the blade.
Q8: A paramedic uses Ketamine for chemical restraint of a patient in a Psychomotor Agitated
State. What is the CORRECT adult dose? A) 40 mg diluted in 100mL NS B) 1.5 mg/kg IV push
C) 4 mg/kg IM once D) 0.15 mg/kg diluted in 100mL NS
● The Answer: C (4 mg/kg IM once)
● Distractor Analysis:
○ A is incorrect: This is the sub-dissociative analgesic dose.
○ B is incorrect: This is a legacy RSI induction dose.
○ D is incorrect: This is the pediatric analgesic dose.
The Mentor's Analysis: Severe agitation requires immediate dissociation to prevent fatal
exertion. By utilizing the 4 mg/kg IM dose, you bypass the trap of sub-therapeutic sedation.
Professional Intuition: Agitation requires dissociation; pain requires analgesia.
Q9: An adult cardiac arrest patient has suspected hyperkalemia from missed dialysis. What is
the CORRECT dose of Calcium Chloride? A) 3g IV/IO rapid push B) 1g IV/IO over 2 minutes C)
20 mg/kg IV/IO over 5 minutes D) 1 mEq/kg IV/IO
● The Answer: B (1g IV/IO over 2 minutes)
● Distractor Analysis:
○ A is incorrect: 3g is the dose for Calcium Gluconate.
○ C is incorrect: 20 mg/kg is the pediatric Calcium Chloride dose.
○ D is incorrect: 1 mEq/kg is the Sodium Bicarbonate dose.
The Mentor's Analysis: Calcium rapidly stabilizes the myocardium against lethal potassium
