SNHD Paramedic Protocols Exam Study Guide
Questions and Answers 2025
/ What is the purpose of the manual? - Answer-To provide guidance for all prehospital
care providers and emergency department physicians within the Clark County EMS
system
/.What is the goal of the manual? - Answer-To standardize prehospital patient care in
Clark County.
/.The protocols are - Answer-Guidelines, nothing contained in these protocols shall be
constructed to expand the scope of practice of any licensed attendant beyond that
which is identified in the CC Emergency Medical Services Regulations and these
protocols
/.Nothing within these protocols is meant to - Answer-Delay rapid patient transport to a
receiving facility. Patient care should be rendered while en-route
/.Order of protocols - Answer-General assessment protocol must be followed in the
specific sequence noted. For all other treatment protocols, the algorithm defines the
care every patient should receive, usually in the order described.
/.A patient is any individual that meets at least one of the following criteria - Answer-A
person who has a complaint or mechanism suggestive of potential illness or injury
A person who has obvious evidence of illness or injury
A person identified by an informed 2nd or 3rd party caller as requiring evaluation for
potential illness or injury
/.Pediatric patient considerations - Answer-For patients < 18 yo, use the Pediatric
Patient Destination protocol.
Pediatric treatment protocols are to be used on children who have not yet experienced
puberty. Signs of puberty include chest or underarm hair on males, and any breast
development on females.
/.The protocols demonstrate a - Answer-Commitment to a consistent approach to quality
patient care
/.General adult assessment 1 - Answer-Scene safety / scene size up
Nature of call / mechanism of injury
PPE / BSI
Bring all equipment to patient's side
,/.General adult assessment 2 - Answer-Level of consciousness -> unresponsive ->
check pulse -> none -> *Cardiac arrest
Airway -> signs of compromise or not protecting -> *ventilation management
Breathing -> inadequate or respiratory distress -> *Respiratory distress
Circulation -> bleeding -> *General trauma
Disability -> altered or confused -> *altered mental status/syncope
/.General adult assessment 3 - Answer-History - HPI & AMPLE
Vital signs and physical exam
Blood glucose testing as indicated
*Specific treatment protocol as indicated
*Cervical stabilization as indicated
Comfort measures (splint, position of comfort)
Cardiac monitor as indicated
Vascular access as indicated
Oxygen therapy to keep SOP2 >94
Pain management as indicated
/.General adult assessment 4 - Answer-Radio contact for all trauma center patients,
Code 3 returns, need for telemetry physician and as per protocol
Transport per Disposition criteria, if applicable
*Transport to closest facility for: airway emergencies (inability to adequately ventilate)
/.Contact with online medical control - Answer-Should only be established by radio.
Telephone contact may only be used if the call is routed via a recorded phone patch
through FAO at 702-382-9007
/.Pediatric patients shall be transported - Answer-In accordance with the pediatric
destination protocol
/.Patients with evidence of a stroke shall be transported - Answer-In accordance with
the Stroke (CVA) Protocol
/.Sexual assault victims <13 yo - Answer-Shall be transported to Sunrise Hospital
/.Sexual assault victims 13 yo to 18 yo - Answer-Shall be transported to Sunrise or UMC
/.Sexual assault victims >18 yo - Answer-Shall be transported to UMC
/.For sexual assault victims outside a 50 mile radius from the above facilities - Answer-
Transport to the nearest appropriate facility
/.Waiting room criteria - Answer-Excluding patients on a legal psychiatric hold, meeting
all of the following criteria
1. Normal vital signs
, 2. Did not receive any parenteral medications during EMS transport except a single
dose of analgesia and/or an antiemetic
3. In the judgment of the paramedic, does not require continuous cardiac monitoring.
Note: any ECG monitoring initiated by a transferring facility may not be discontinued by
EMS personnel
4. Can maintain a sitting position without adverse impact on their medical condition
5. Is left with a verbal report to hospital personnel
/.Waiting room vital signs - Answer-Heart rate: 60-100
Respiratory rate: 10-20
Systolic BP: 100-180
Diastolic BP: 60-110
Room air pulse oximetry >94%
Alert and oriented x 4
/.Internal disaster - Answer-Facility is to be bypassed for all patients except patients in
cardiac arrest or in whom the ability to adequately ventilate has not been established
/.General adult trauma assessment 1 - Answer-General adult assessment
Cervical stabilization
/.General adult trauma assessment 2 - Answer-GCS < 8 -> *Ventilation management:
BVM if O2 < 94%
GCS >8 -> Oxygen keep SPO2 > 94%
/.General adult trauma assessment 3 - Answer-Palpable radial pulse?
Yes -> Vascular access
No -> Vascular access -> 1 L NS or LR bolus IV/IO
/.General adult trauma assessment 4 - Answer-Secondary assessment:
Suspected tension pneumothorax -> *Needle Thoracentesis
Sucking chest wound -> Apply 3 sided occlusive dressing
Control active hemorrhage -> *Hemorrhage control
Obvious fractures -> Immobilize fractures; assess distal pulse
Suspected traumatic brain injury -> Raise head of bed 30 degrees and capnography -
ETCO2 35 mmHg
Open wounds -> cover with gauze; wet trauma dressing for abdominal evisceration
/.General adult trauma assessment 5 - Answer-Pain management
Transport and radio contact to appropriate Trauma Center based on TFTC
/.Abdominal/Flank Pain, nausea and Vomiting 1 - Answer-General adult assessment
12 Lead ECG if age > 35 yo
/.Abdominal/Flank Pain, nausea and Vomiting 2 - Answer-Signs of hypovolemia?
Yes -> vascular access -> 500 mL NS or LR bolus IV/IO; may repeat up to 2000 ml
Questions and Answers 2025
/ What is the purpose of the manual? - Answer-To provide guidance for all prehospital
care providers and emergency department physicians within the Clark County EMS
system
/.What is the goal of the manual? - Answer-To standardize prehospital patient care in
Clark County.
/.The protocols are - Answer-Guidelines, nothing contained in these protocols shall be
constructed to expand the scope of practice of any licensed attendant beyond that
which is identified in the CC Emergency Medical Services Regulations and these
protocols
/.Nothing within these protocols is meant to - Answer-Delay rapid patient transport to a
receiving facility. Patient care should be rendered while en-route
/.Order of protocols - Answer-General assessment protocol must be followed in the
specific sequence noted. For all other treatment protocols, the algorithm defines the
care every patient should receive, usually in the order described.
/.A patient is any individual that meets at least one of the following criteria - Answer-A
person who has a complaint or mechanism suggestive of potential illness or injury
A person who has obvious evidence of illness or injury
A person identified by an informed 2nd or 3rd party caller as requiring evaluation for
potential illness or injury
/.Pediatric patient considerations - Answer-For patients < 18 yo, use the Pediatric
Patient Destination protocol.
Pediatric treatment protocols are to be used on children who have not yet experienced
puberty. Signs of puberty include chest or underarm hair on males, and any breast
development on females.
/.The protocols demonstrate a - Answer-Commitment to a consistent approach to quality
patient care
/.General adult assessment 1 - Answer-Scene safety / scene size up
Nature of call / mechanism of injury
PPE / BSI
Bring all equipment to patient's side
,/.General adult assessment 2 - Answer-Level of consciousness -> unresponsive ->
check pulse -> none -> *Cardiac arrest
Airway -> signs of compromise or not protecting -> *ventilation management
Breathing -> inadequate or respiratory distress -> *Respiratory distress
Circulation -> bleeding -> *General trauma
Disability -> altered or confused -> *altered mental status/syncope
/.General adult assessment 3 - Answer-History - HPI & AMPLE
Vital signs and physical exam
Blood glucose testing as indicated
*Specific treatment protocol as indicated
*Cervical stabilization as indicated
Comfort measures (splint, position of comfort)
Cardiac monitor as indicated
Vascular access as indicated
Oxygen therapy to keep SOP2 >94
Pain management as indicated
/.General adult assessment 4 - Answer-Radio contact for all trauma center patients,
Code 3 returns, need for telemetry physician and as per protocol
Transport per Disposition criteria, if applicable
*Transport to closest facility for: airway emergencies (inability to adequately ventilate)
/.Contact with online medical control - Answer-Should only be established by radio.
Telephone contact may only be used if the call is routed via a recorded phone patch
through FAO at 702-382-9007
/.Pediatric patients shall be transported - Answer-In accordance with the pediatric
destination protocol
/.Patients with evidence of a stroke shall be transported - Answer-In accordance with
the Stroke (CVA) Protocol
/.Sexual assault victims <13 yo - Answer-Shall be transported to Sunrise Hospital
/.Sexual assault victims 13 yo to 18 yo - Answer-Shall be transported to Sunrise or UMC
/.Sexual assault victims >18 yo - Answer-Shall be transported to UMC
/.For sexual assault victims outside a 50 mile radius from the above facilities - Answer-
Transport to the nearest appropriate facility
/.Waiting room criteria - Answer-Excluding patients on a legal psychiatric hold, meeting
all of the following criteria
1. Normal vital signs
, 2. Did not receive any parenteral medications during EMS transport except a single
dose of analgesia and/or an antiemetic
3. In the judgment of the paramedic, does not require continuous cardiac monitoring.
Note: any ECG monitoring initiated by a transferring facility may not be discontinued by
EMS personnel
4. Can maintain a sitting position without adverse impact on their medical condition
5. Is left with a verbal report to hospital personnel
/.Waiting room vital signs - Answer-Heart rate: 60-100
Respiratory rate: 10-20
Systolic BP: 100-180
Diastolic BP: 60-110
Room air pulse oximetry >94%
Alert and oriented x 4
/.Internal disaster - Answer-Facility is to be bypassed for all patients except patients in
cardiac arrest or in whom the ability to adequately ventilate has not been established
/.General adult trauma assessment 1 - Answer-General adult assessment
Cervical stabilization
/.General adult trauma assessment 2 - Answer-GCS < 8 -> *Ventilation management:
BVM if O2 < 94%
GCS >8 -> Oxygen keep SPO2 > 94%
/.General adult trauma assessment 3 - Answer-Palpable radial pulse?
Yes -> Vascular access
No -> Vascular access -> 1 L NS or LR bolus IV/IO
/.General adult trauma assessment 4 - Answer-Secondary assessment:
Suspected tension pneumothorax -> *Needle Thoracentesis
Sucking chest wound -> Apply 3 sided occlusive dressing
Control active hemorrhage -> *Hemorrhage control
Obvious fractures -> Immobilize fractures; assess distal pulse
Suspected traumatic brain injury -> Raise head of bed 30 degrees and capnography -
ETCO2 35 mmHg
Open wounds -> cover with gauze; wet trauma dressing for abdominal evisceration
/.General adult trauma assessment 5 - Answer-Pain management
Transport and radio contact to appropriate Trauma Center based on TFTC
/.Abdominal/Flank Pain, nausea and Vomiting 1 - Answer-General adult assessment
12 Lead ECG if age > 35 yo
/.Abdominal/Flank Pain, nausea and Vomiting 2 - Answer-Signs of hypovolemia?
Yes -> vascular access -> 500 mL NS or LR bolus IV/IO; may repeat up to 2000 ml
