THE ELITE UNIVERSAL TEST
BANK: KENTUCKY
EMS/PARAMEDIC STATE
PROTOCOL EXAM
PART 0: THE NAVIGATOR
● Tier 1: Foundational Syntax & Application (Questions 1–28)
○ Focus: Hard-deck definitions, Kentucky Revised Statutes (KRS 311A, KRS 209),
and 2025/2026 baseline clinical thresholds (Trauma Triage, Determination of
Death).
● Tier 2: Complex Application & Simulation (Questions 29–58)
○ Focus: Dynamic field simulations, pharmacology algorithms (Refractory VF,
DSD/Vector Change, Agitation), and critical scope-of-practice deviations.
● Tier 3: Grandmaster Synthesis (Questions 59–88)
○ Focus: High-stakes, multi-variable triage, integration of Mobile Stroke Units (MSU),
complex pediatric trauma, and multi-system ethical/legal dilemmas.
PART I: THE PRIMER
You are here to master the 2025/2026 Kentucky State EMS Protocols, a framework where
clinical precision intersects with uncompromising statutory mandates. Mastery of this document
translates directly into elite prehospital execution, ensuring your decisions are medically
flawless and legally impenetrable.
The "Critical Axioms" Cheat Sheet:
● The DOD Matrix: Prehospital determination of death requires five absolute signs
(Unresponsiveness, Apnea, Pulselessness, Fixed/Dilated Pupils, Asystole in 2 leads)
PLUS one associated factor (Lividity, Rigor, Pooling, or Destruction).
● Refractory VF/VT Protocol: After three (3) unsuccessful defibrillation attempts,
immediately transition to Vector Change (VC) or Double Sequential Defibrillation (DSD).
● The 30-Day Safe Harbor: Under the updated Thomas J. Burch Safe Infants Act, parents
may surrender an unharmed infant up to 30 days old without consequence.
● Trauma Triage Hard-Decks: Adult Major Trauma activates at a Glasgow Coma Scale
(GCS) \le 13, Systolic BP < 90, or Respiratory Rate < 10 or > 29.
● Chemical Restraint Redline: For severe, dangerous agitation, the updated Ketamine IV
dosing is 4-5 mg/kg, overriding legacy conservative dosing to ensure immediate provider
and patient safety.
,Triage Category Age Parameter Neurological Trigger Hemodynamic Trigger
Adult Major Trauma \ge 16 years GCS \le 13 SBP < 90 mmHg
Pediatric Major < 16 years GCS < 14 SBP < [70 + (2 x Age)]
Trauma
Safe Infants Act \le 30 days N/A (Unharmed) N/A (Unharmed)
PART II: THE ELITE TEST BANK
Q1: A paramedic evaluates a normothermic patient in cardiac arrest. The patient exhibits
unresponsiveness, apnea, pulselessness, and fixed/dilated pupils. Asystole is confirmed in two
leads. Based on KRS 311A.185 and Kentucky Determination of Death protocols, which
additional factor is REQUIRED to pronounce death without online medical control? A) A
confirmed downtime exceeding 20 minutes prior to EMS arrival. B) The presence of a valid
out-of-state Do Not Resuscitate (DNR) order. C) The presence of lividity, rigor mortis, venous
pooling, or tissue destruction. D) The administration of at least one round of advanced life
support (ALS) medications.
● The Answer: C (The presence of lividity, rigor mortis, venous pooling, or tissue
destruction.)
● Distractor Analysis:
○ A is incorrect: Downtime is subjective and is not a standalone statutory factor for
field pronouncement.
○ B is incorrect: Out-of-state DNRs require specific validation; they are not an
automatic associated physical factor.
○ D is incorrect: If the five signs and one associated factor are present, ALS
administration is legally withheld.
The Mentor's Analysis: Kentucky law removes ambiguity from death pronouncement by
requiring absolute physical evidence of irreversibility. When evaluating a medical arrest, the
immediate priority is identifying structural decay. By utilizing the 5+1 matrix, you bypass the
common trap of premature termination. Professional/Academic Intuition: Never pronounce a
medical cardiac arrest without one of the four definitive physical factors of death: lividity,
rigor, pooling, or destruction.
Q2: Under the 2025/2026 Kentucky Trauma Triage Guidelines, an adult patient who suffered a
10-foot fall presents with stable vital signs but a GCS score of 13. Which action is the MOST
APPROPRIATE triage designation? A) Routine transport to a Level IV facility for observation. B)
Transport to a Level III facility only if the patient becomes hypotensive. C) Adult Major Trauma
criteria met; transport to the highest level trauma center available. D) Geriatric trauma criteria
met; upgrade only if the patient is over 65.
● The Answer: C (Adult Major Trauma criteria met; transport to the highest level trauma
center available.)
● Distractor Analysis:
○ A is incorrect: A GCS of 13 triggers major trauma criteria; routing to a Level IV
facility is negligent undertriage.
○ B is incorrect: Hypotension is an independent trigger; a GCS of 13 stands alone as
a mandate.
○ D is incorrect: GCS \le 13 applies to all adult patients regardless of the geriatric
modifier.
The Mentor's Analysis: Neurological decay is the premier predictor of trauma mortality. When
assessing head trauma, the immediate priority is recognizing subtle cognitive shifts. By utilizing
the hard-deck GCS 13 threshold, you bypass the common trap of underestimating closed head
,injuries. Professional/Academic Intuition: An adult GCS \le 13 instantly mandates Adult Major
Trauma activation, regardless of stable hemodynamics.
Q3: Following an opioid overdose reversal, a patient refuses transport. The paramedic provides
a naloxone kit to the patient’s family. Under the 2025 KBEMS Leave Behind Naloxone Protocol,
this action is: A) Prohibited, as naloxone may only be dispensed by a licensed pharmacist. B)
Prohibited, unless the patient signs a specific medical necessity waiver. C) Permitted and
indicated for anyone at risk of overdose or likely to witness one. D) Permitted, provided the
paramedic holds an Advanced Practice Paramedic (APP) license.
● The Answer: C (Permitted and indicated for anyone at risk of overdose or likely to witness
one.)
● Distractor Analysis:
○ A is incorrect: The Leave Behind protocol explicitly authorizes EMS distribution to
bypass pharmacy friction.
○ B is incorrect: No medical necessity waiver is required to distribute an antagonist to
a bystander.
○ D is incorrect: All certified EMS providers may execute the Leave Behind protocol
after training.
The Mentor's Analysis: Harm reduction requires saturation at the point of failure. When
encountering refusal of transport after an overdose, the immediate priority is preventing the
inevitable secondary arrest. By distributing naloxone on scene, you bypass the common trap of
leaving vulnerable networks unprotected. Professional/Academic Intuition: If a bystander is
likely to witness an overdose, EMS is fully authorized to distribute naloxone kits directly
on scene.
Q4: A mother presents to an EMS station to surrender her newborn under the Thomas J. Burch
Safe Infants Act. According to 2025 Kentucky protocol updates, the infant must be medically
determined to be NO OLDER than: A) 72 hours. B) 7 days. C) 30 days. D) 60 days.
● The Answer: C (30 days.)
● Distractor Analysis:
○ A is incorrect: 72 hours is the outdated legacy protocol parameter.
○ B is incorrect: 7 days is a common misinterpretation of surrounding regional state
laws.
○ D is incorrect: 60 days exceeds the updated statutory protection window.
The Mentor's Analysis: Legislative updates expanded the protective window to prevent
infanticide and abandonment. When receiving a surrendered infant, the immediate priority is
verifying the child is unharmed and within the age limit. By recognizing the 30-day window, you
bypass the common trap of rejecting legal surrenders. Professional/Academic Intuition: The
Kentucky Safe Infants Act provides total legal immunity for surrendering an unharmed
infant up to 30 days of age.
Q5: An Advanced EMT (AEMT) wishes to administer Diphenhydramine to an adult patient.
Under the Kentucky EMS Scope of Practice, the AEMT may ONLY administer this medication
for which specific presentation? A) Acute dystonic reaction. B) Mild seasonal rhinitis. C) Allergic
reaction/Anaphylaxis. D) Insomnia secondary to transport anxiety.
● The Answer: C (Allergic reaction/Anaphylaxis.)
● Distractor Analysis:
○ A is incorrect: Dystonic reactions require paramedic-level differential diagnosis and
intervention.
○ B is incorrect: Routine rhinitis does not warrant prehospital IV/IM antihistamine
therapy.
, ○ D is incorrect: Chemical sedation is strictly outside the AEMT scope of practice.
The Mentor's Analysis: Scope of practice limitations protect both the patient and the provider
from diagnostic overreach. When an AEMT carries Diphenhydramine, the immediate priority is
reserving it for cascade emergencies. By limiting its use, the state bypasses the common trap of
inappropriate antihistamine administration. Professional/Academic Intuition: AEMT
administration of Diphenhydramine is strictly siloed to allergic reaction and anaphylaxis.
Q6: A paramedic is managing an adult patient in cardiac arrest with refractory Ventricular
Fibrillation (VF). The paramedic has delivered 3 unsuccessful defibrillations. Based on 2025
protocols, what is the IMMEDIATE next intervention regarding electrical therapy? A) Administer
Amiodarone 300mg before attempting a 4th shock. B) Perform Vector Change (VC) by placing a
new set of pads in an Anterior-Posterior configuration. C) Increase the energy setting to 400J on
the current pads. D) Withhold defibrillation for 4 minutes to allow CPR to prime the myocardium.
● The Answer: B (Perform Vector Change (VC) by placing a new set of pads in an
Anterior-Posterior configuration.)
● Distractor Analysis:
○ A is incorrect: While antiarrhythmics are indicated, pad vector change is the specific
electrical intervention mandated after 3 failed shocks.
○ C is incorrect: Most prehospital biphasic monitors max out at 200J or 360J; arbitrary
energy increases are impossible.
○ D is incorrect: Withholding indicated shocks fundamentally violates AHA and
Kentucky arrest guidelines.
The Mentor's Analysis: Refractory VF implies the current electrical vector is failing to capture a
critical mass of myocardium. When shocks fail, the immediate priority is redirecting the current.
By shifting to an Anterior-Posterior vector, you bypass the common trap of shocking the same
dead tissue. Professional/Academic Intuition: Three failed shocks in VF mandates an
immediate Vector Change (Anterior-Posterior) or Double Sequential Defibrillation.
Q7: An elderly patient with a fractured hip rates their pain as 8/10. The paramedic prepares to
administer Ketamine for analgesia. The correct 2025 Kentucky protocol dosage for IV Ketamine
for PAIN is: A) 4-5 mg/kg IV slowly. B) 2.0 mg/kg IV push. C) 0.15 mg/kg IV slowly. D) 1.0 mg/kg
IM.
● The Answer: C (0.15 mg/kg IV slowly.)
● Distractor Analysis:
○ A is incorrect: 4-5 mg/kg is the severe agitation/dissociation dose, representing a
massive overdose for simple analgesia.
○ B is incorrect: 2.0 mg/kg is a standard rapid sequence intubation (RSI) induction
dose.
○ D is incorrect: While IM is an alternative route, the IV dose is specifically capped at
sub-dissociative levels.
The Mentor's Analysis: Ketamine is highly dose-dependent. When managing pain, the
immediate priority is preserving airway reflexes. By utilizing sub-dissociative dosing, you bypass
the common trap of accidentally paralyzing the patient's respiratory drive.
Professional/Academic Intuition: For analgesia, Ketamine is strictly capped at the
sub-dissociative threshold of 0.15 mg/kg IV.
Q8: A paramedic determines that a trauma patient meets the 5 signs of death plus the
associated factor of decapitation. The paramedic pronounces the patient dead. Regarding the
scene, the paramedic MUST: A) Remove the body to the ambulance to shield it from public
view. B) Request law enforcement and the Coroner, ensuring the area surrounding the corpse is
not disturbed. C) Remove all medical equipment used during the assessment from the body. D)
BANK: KENTUCKY
EMS/PARAMEDIC STATE
PROTOCOL EXAM
PART 0: THE NAVIGATOR
● Tier 1: Foundational Syntax & Application (Questions 1–28)
○ Focus: Hard-deck definitions, Kentucky Revised Statutes (KRS 311A, KRS 209),
and 2025/2026 baseline clinical thresholds (Trauma Triage, Determination of
Death).
● Tier 2: Complex Application & Simulation (Questions 29–58)
○ Focus: Dynamic field simulations, pharmacology algorithms (Refractory VF,
DSD/Vector Change, Agitation), and critical scope-of-practice deviations.
● Tier 3: Grandmaster Synthesis (Questions 59–88)
○ Focus: High-stakes, multi-variable triage, integration of Mobile Stroke Units (MSU),
complex pediatric trauma, and multi-system ethical/legal dilemmas.
PART I: THE PRIMER
You are here to master the 2025/2026 Kentucky State EMS Protocols, a framework where
clinical precision intersects with uncompromising statutory mandates. Mastery of this document
translates directly into elite prehospital execution, ensuring your decisions are medically
flawless and legally impenetrable.
The "Critical Axioms" Cheat Sheet:
● The DOD Matrix: Prehospital determination of death requires five absolute signs
(Unresponsiveness, Apnea, Pulselessness, Fixed/Dilated Pupils, Asystole in 2 leads)
PLUS one associated factor (Lividity, Rigor, Pooling, or Destruction).
● Refractory VF/VT Protocol: After three (3) unsuccessful defibrillation attempts,
immediately transition to Vector Change (VC) or Double Sequential Defibrillation (DSD).
● The 30-Day Safe Harbor: Under the updated Thomas J. Burch Safe Infants Act, parents
may surrender an unharmed infant up to 30 days old without consequence.
● Trauma Triage Hard-Decks: Adult Major Trauma activates at a Glasgow Coma Scale
(GCS) \le 13, Systolic BP < 90, or Respiratory Rate < 10 or > 29.
● Chemical Restraint Redline: For severe, dangerous agitation, the updated Ketamine IV
dosing is 4-5 mg/kg, overriding legacy conservative dosing to ensure immediate provider
and patient safety.
,Triage Category Age Parameter Neurological Trigger Hemodynamic Trigger
Adult Major Trauma \ge 16 years GCS \le 13 SBP < 90 mmHg
Pediatric Major < 16 years GCS < 14 SBP < [70 + (2 x Age)]
Trauma
Safe Infants Act \le 30 days N/A (Unharmed) N/A (Unharmed)
PART II: THE ELITE TEST BANK
Q1: A paramedic evaluates a normothermic patient in cardiac arrest. The patient exhibits
unresponsiveness, apnea, pulselessness, and fixed/dilated pupils. Asystole is confirmed in two
leads. Based on KRS 311A.185 and Kentucky Determination of Death protocols, which
additional factor is REQUIRED to pronounce death without online medical control? A) A
confirmed downtime exceeding 20 minutes prior to EMS arrival. B) The presence of a valid
out-of-state Do Not Resuscitate (DNR) order. C) The presence of lividity, rigor mortis, venous
pooling, or tissue destruction. D) The administration of at least one round of advanced life
support (ALS) medications.
● The Answer: C (The presence of lividity, rigor mortis, venous pooling, or tissue
destruction.)
● Distractor Analysis:
○ A is incorrect: Downtime is subjective and is not a standalone statutory factor for
field pronouncement.
○ B is incorrect: Out-of-state DNRs require specific validation; they are not an
automatic associated physical factor.
○ D is incorrect: If the five signs and one associated factor are present, ALS
administration is legally withheld.
The Mentor's Analysis: Kentucky law removes ambiguity from death pronouncement by
requiring absolute physical evidence of irreversibility. When evaluating a medical arrest, the
immediate priority is identifying structural decay. By utilizing the 5+1 matrix, you bypass the
common trap of premature termination. Professional/Academic Intuition: Never pronounce a
medical cardiac arrest without one of the four definitive physical factors of death: lividity,
rigor, pooling, or destruction.
Q2: Under the 2025/2026 Kentucky Trauma Triage Guidelines, an adult patient who suffered a
10-foot fall presents with stable vital signs but a GCS score of 13. Which action is the MOST
APPROPRIATE triage designation? A) Routine transport to a Level IV facility for observation. B)
Transport to a Level III facility only if the patient becomes hypotensive. C) Adult Major Trauma
criteria met; transport to the highest level trauma center available. D) Geriatric trauma criteria
met; upgrade only if the patient is over 65.
● The Answer: C (Adult Major Trauma criteria met; transport to the highest level trauma
center available.)
● Distractor Analysis:
○ A is incorrect: A GCS of 13 triggers major trauma criteria; routing to a Level IV
facility is negligent undertriage.
○ B is incorrect: Hypotension is an independent trigger; a GCS of 13 stands alone as
a mandate.
○ D is incorrect: GCS \le 13 applies to all adult patients regardless of the geriatric
modifier.
The Mentor's Analysis: Neurological decay is the premier predictor of trauma mortality. When
assessing head trauma, the immediate priority is recognizing subtle cognitive shifts. By utilizing
the hard-deck GCS 13 threshold, you bypass the common trap of underestimating closed head
,injuries. Professional/Academic Intuition: An adult GCS \le 13 instantly mandates Adult Major
Trauma activation, regardless of stable hemodynamics.
Q3: Following an opioid overdose reversal, a patient refuses transport. The paramedic provides
a naloxone kit to the patient’s family. Under the 2025 KBEMS Leave Behind Naloxone Protocol,
this action is: A) Prohibited, as naloxone may only be dispensed by a licensed pharmacist. B)
Prohibited, unless the patient signs a specific medical necessity waiver. C) Permitted and
indicated for anyone at risk of overdose or likely to witness one. D) Permitted, provided the
paramedic holds an Advanced Practice Paramedic (APP) license.
● The Answer: C (Permitted and indicated for anyone at risk of overdose or likely to witness
one.)
● Distractor Analysis:
○ A is incorrect: The Leave Behind protocol explicitly authorizes EMS distribution to
bypass pharmacy friction.
○ B is incorrect: No medical necessity waiver is required to distribute an antagonist to
a bystander.
○ D is incorrect: All certified EMS providers may execute the Leave Behind protocol
after training.
The Mentor's Analysis: Harm reduction requires saturation at the point of failure. When
encountering refusal of transport after an overdose, the immediate priority is preventing the
inevitable secondary arrest. By distributing naloxone on scene, you bypass the common trap of
leaving vulnerable networks unprotected. Professional/Academic Intuition: If a bystander is
likely to witness an overdose, EMS is fully authorized to distribute naloxone kits directly
on scene.
Q4: A mother presents to an EMS station to surrender her newborn under the Thomas J. Burch
Safe Infants Act. According to 2025 Kentucky protocol updates, the infant must be medically
determined to be NO OLDER than: A) 72 hours. B) 7 days. C) 30 days. D) 60 days.
● The Answer: C (30 days.)
● Distractor Analysis:
○ A is incorrect: 72 hours is the outdated legacy protocol parameter.
○ B is incorrect: 7 days is a common misinterpretation of surrounding regional state
laws.
○ D is incorrect: 60 days exceeds the updated statutory protection window.
The Mentor's Analysis: Legislative updates expanded the protective window to prevent
infanticide and abandonment. When receiving a surrendered infant, the immediate priority is
verifying the child is unharmed and within the age limit. By recognizing the 30-day window, you
bypass the common trap of rejecting legal surrenders. Professional/Academic Intuition: The
Kentucky Safe Infants Act provides total legal immunity for surrendering an unharmed
infant up to 30 days of age.
Q5: An Advanced EMT (AEMT) wishes to administer Diphenhydramine to an adult patient.
Under the Kentucky EMS Scope of Practice, the AEMT may ONLY administer this medication
for which specific presentation? A) Acute dystonic reaction. B) Mild seasonal rhinitis. C) Allergic
reaction/Anaphylaxis. D) Insomnia secondary to transport anxiety.
● The Answer: C (Allergic reaction/Anaphylaxis.)
● Distractor Analysis:
○ A is incorrect: Dystonic reactions require paramedic-level differential diagnosis and
intervention.
○ B is incorrect: Routine rhinitis does not warrant prehospital IV/IM antihistamine
therapy.
, ○ D is incorrect: Chemical sedation is strictly outside the AEMT scope of practice.
The Mentor's Analysis: Scope of practice limitations protect both the patient and the provider
from diagnostic overreach. When an AEMT carries Diphenhydramine, the immediate priority is
reserving it for cascade emergencies. By limiting its use, the state bypasses the common trap of
inappropriate antihistamine administration. Professional/Academic Intuition: AEMT
administration of Diphenhydramine is strictly siloed to allergic reaction and anaphylaxis.
Q6: A paramedic is managing an adult patient in cardiac arrest with refractory Ventricular
Fibrillation (VF). The paramedic has delivered 3 unsuccessful defibrillations. Based on 2025
protocols, what is the IMMEDIATE next intervention regarding electrical therapy? A) Administer
Amiodarone 300mg before attempting a 4th shock. B) Perform Vector Change (VC) by placing a
new set of pads in an Anterior-Posterior configuration. C) Increase the energy setting to 400J on
the current pads. D) Withhold defibrillation for 4 minutes to allow CPR to prime the myocardium.
● The Answer: B (Perform Vector Change (VC) by placing a new set of pads in an
Anterior-Posterior configuration.)
● Distractor Analysis:
○ A is incorrect: While antiarrhythmics are indicated, pad vector change is the specific
electrical intervention mandated after 3 failed shocks.
○ C is incorrect: Most prehospital biphasic monitors max out at 200J or 360J; arbitrary
energy increases are impossible.
○ D is incorrect: Withholding indicated shocks fundamentally violates AHA and
Kentucky arrest guidelines.
The Mentor's Analysis: Refractory VF implies the current electrical vector is failing to capture a
critical mass of myocardium. When shocks fail, the immediate priority is redirecting the current.
By shifting to an Anterior-Posterior vector, you bypass the common trap of shocking the same
dead tissue. Professional/Academic Intuition: Three failed shocks in VF mandates an
immediate Vector Change (Anterior-Posterior) or Double Sequential Defibrillation.
Q7: An elderly patient with a fractured hip rates their pain as 8/10. The paramedic prepares to
administer Ketamine for analgesia. The correct 2025 Kentucky protocol dosage for IV Ketamine
for PAIN is: A) 4-5 mg/kg IV slowly. B) 2.0 mg/kg IV push. C) 0.15 mg/kg IV slowly. D) 1.0 mg/kg
IM.
● The Answer: C (0.15 mg/kg IV slowly.)
● Distractor Analysis:
○ A is incorrect: 4-5 mg/kg is the severe agitation/dissociation dose, representing a
massive overdose for simple analgesia.
○ B is incorrect: 2.0 mg/kg is a standard rapid sequence intubation (RSI) induction
dose.
○ D is incorrect: While IM is an alternative route, the IV dose is specifically capped at
sub-dissociative levels.
The Mentor's Analysis: Ketamine is highly dose-dependent. When managing pain, the
immediate priority is preserving airway reflexes. By utilizing sub-dissociative dosing, you bypass
the common trap of accidentally paralyzing the patient's respiratory drive.
Professional/Academic Intuition: For analgesia, Ketamine is strictly capped at the
sub-dissociative threshold of 0.15 mg/kg IV.
Q8: A paramedic determines that a trauma patient meets the 5 signs of death plus the
associated factor of decapitation. The paramedic pronounces the patient dead. Regarding the
scene, the paramedic MUST: A) Remove the body to the ambulance to shield it from public
view. B) Request law enforcement and the Coroner, ensuring the area surrounding the corpse is
not disturbed. C) Remove all medical equipment used during the assessment from the body. D)
