Elite Universal Test
Bank: New Brunswick
EMS/Paramedic
Provincial Protocol
Mastery
PART 0: THE NAVIGATOR
● PART I: THE PRIMER
○ The Prehospital Vanguard: Narrative synthesis of the Ambulance New Brunswick
(ANB) and Paramedic Association of New Brunswick (PANB) operational
frameworks.
○ The "Critical Axioms" Cheat Sheet: Non-negotiable clinical hard-decks for the
2026/2027 operative year.
● PART II: THE ELITE TEST BANK
○ Tier 1 (Questions 1–28) - Foundational Syntax & Application: Protocol
hardlines, pharmacological scope limitations (PCP vs. ACP), and baseline Field
Trauma Triage Guidelines (FTTG).
○ Tier 2 (Questions 29–58) - Complex Application & Simulation: Variable-driven
scenarios assessing Rapid Sequence Intubation (RSI) hemodynamics, S-LAMS
stroke bypass calculations, and Extra-Mural Program (EMP) palliative integration.
○ Tier 3 (Questions 59–88) - Grandmaster Synthesis: High-stakes, multi-system
emergencies integrating refractory cardiac arrest protocols, blood shortage disaster
triage, and severe ethical dilemmas.
PART I: THE PRIMER
Mastering the Ambulance New Brunswick (ANB) clinical directives transcends rote
memorization; it demands algorithmic, instinctual execution under profound physiological and
environmental pressure. This document forges practitioners into elite clinical operators,
translating complex provincial mandates—such as the integrated Extra-Mural Program (EMP)
palliative pathways and the advanced Field Trauma Triage Guidelines (FTTG)—directly into
decisive, high-stakes prehospital intervention.
The paramedic profession in New Brunswick has evolved into a highly autonomous, highly
regulated medical specialty. Governed by the Paramedic Association of New Brunswick (PANB)
,and strictly aligned with the 2024 National Competency Framework for Paramedics (NCFP),
clinicians are mandated to operate as reflective practitioners, accumulating 64 educational
credits annually to maintain rigorous clinical parity with national standards. The system relies on
a stratified scope of practice. Primary Care Paramedics (PCPs) independently manage
advanced airways, initiate intravenous therapy, and administer ten distinct pharmacological
classifications, including sympathomimetics and opioid antagonists. Advanced Care Paramedics
(ACPs) operate as field intensivists, wielding an expanded formulary that includes
antidysrhythmics, benzodiazepines, and advanced procedural capabilities such as Rapid
Sequence Intubation (RSI) and needle thoracostomy.
Recent protocol evolutions have radically altered prehospital algorithms to optimize survivability
and hospital utilization. The implementation of the EMP palliative collaborative directive
empowers paramedics to administer symptom-relief medications (e.g., Haloperidol,
Glycopyrrolate) and refer terminal patients to community care, effectively bypassing the
emergency department. Simultaneously, trauma and neurovascular triage algorithms have
shifted toward definitive care pathways. The FTTG Step 1A criteria require practitioners to
recognize "Immediate Life Threats" and bypass non-surgical Level V facilities in favor of Level I,
II, or III trauma centers. Similarly, the adoption of the S-LAMS assessment tool forces the early
identification of Large Vessel Occlusions (LVO), redirecting patients to Endovascular
Thrombectomy (EVT) centers within a 24-hour window.
The "Critical Axioms" Cheat Sheet
Clinical Domain Actionable Directive & Rationale
Trauma Triage (FTTG) Step 1A Absolute: Physiologic compromise
(GCS < 8, hypotension) supersedes transport
distance. You MUST bypass Level V centers for
Level I, II, or III surgical facilities.
Airway / RSI The Hemodynamic Rule: Pre-intubation shock
index (\ge 0.8) demands resuscitation before
paralysis. Ketamine induction doses must be
halved in uncompensated shock. Target a
post-intubation RASS of -4 and CPOT of 0.
Cardiac Arrest The Catecholamine Cap: Epinephrine
administration in cardiac arrest is strictly
capped at a maximum of 5 doses to prevent
severe end-organ ischemia. For refractory
VF/pVT, initiate a vector change
(anterior/posterior pads).
Palliative / EMP The Dignity Directive: Palliative patients
demonstrating capacity qualify for the "treat and
refer" pathway. Utilize Haloperidol for
delirium/nausea and Glycopyrrolate for terminal
secretions.
Blood Shortage The Red Phase Mandate: During a critical
provincial blood shortage (Red Phase), blood
products are completely withheld from patients
with a systolic BP < 70 mmHg who are
,Clinical Domain Actionable Directive & Rationale
unconscious and unresponsive to fluid
resuscitation.
PART II: THE ELITE TEST BANK
Tier 1 - Foundational Syntax & Application
Q1: Under the New Brunswick Field Trauma Triage Guidelines (FTTG), a patient presents with
an open femur fracture, GCS 14, and a systolic blood pressure of 85 mmHg. Based on Step 1
criteria, what is the MOST APPROPRIATE destination logic? A) Transport to the closest Level V
facility for fluid resuscitation prior to secondary transfer. B) Transport directly to a Level I, II, or III
Trauma Center, bypassing any Level V facility. C) Remain on scene and initiate a mandatory
Epinephrine infusion to correct the hypotension. D) Request air medical transport and refuse
ground transport to preserve clot integrity.
● The Answer: B (Transport directly to a Level I, II, or III Trauma Center, bypassing any
Level V facility)
● Distractor Analysis:
○ A is incorrect: Level V bypass is mandatory for physiological Step 1 criteria
(hypotension).
○ C is incorrect: Vasopressors are contraindicated in hemorrhagic shock.
○ D is incorrect: Ground transport must be initiated if air transport causes definitive
care delays.
The Mentor's Analysis: Hypotension in trauma defines uncompensated hemorrhagic shock.
Level V facilities lack the surgical capability to achieve damage control. Professional/Academic
Intuition: Never transport bleeding physiology to a non-surgical facility.
Q2: According to the PANB standards aligned with the 2024 NCFP, which specific
pharmacological classification is explicitly RESTRICTED from the Primary Care Paramedic
(PCP) scope of practice? A) Antihypoglycemic hormones B) Sympathomimetics C)
Antidysrhythmics D) Opioid antagonists
● The Answer: C (Antidysrhythmics)
● Distractor Analysis:
○ A is incorrect: PCPs administer Glucagon (Antihypoglycemic).
○ B is incorrect: PCPs administer Epinephrine/Salbutamol (Sympathomimetics).
○ D is incorrect: PCPs administer Naloxone (Opioid antagonist).
The Mentor's Analysis: The NCFP stratifies risk. Complex electrical manipulation via
antidysrhythmics (e.g., Amiodarone) requires Advanced Care Paramedic (ACP) intensive
rhythm analysis. Professional/Academic Intuition: PCPs manage the plumbing and the pump
rate; ACPs manage the specific electrical circuitry.
Q3: You are evaluating a patient with sudden onset left-sided weakness. You calculate a Los
Angeles Motor Scale (S-LAMS) score of 5. Based on New York and emerging stroke bypass
protocols integrated globally, what does this score IMMEDIATELY indicate? A) A transient
ischemic attack requiring routine local transport. B) A suspected Large Vessel Occlusion (LVO)
requiring bypass to an Endovascular Thrombectomy (EVT) center. C) A hemorrhagic stroke
requiring an immediate field infusion of Tranexamic Acid (TXA). D) A minor ischemic event
eligible for the treat-and-refer EMP pathway.
● The Answer: B (A suspected Large Vessel Occlusion (LVO) requiring bypass to an
Endovascular Thrombectomy (EVT) center)
, ● Distractor Analysis:
○ A is incorrect: S-LAMS \ge 4 indicates severe, active occlusion.
○ C is incorrect: TXA is not administered for undifferentiated stroke in the field.
○ D is incorrect: EMP pathways are for palliative/chronic conditions, not acute
neurovascular emergencies.
The Mentor's Analysis: The S-LAMS tool specifically predicts the presence of an LVO. Primary
stroke centers can administer thrombolytics, but only EVT centers can mechanically retrieve
large clots. Professional/Academic Intuition: A high LAMS score is the mechanical retrieval
trigger; bypass the primary center if time permits.
Q4: During an adult cardiac arrest, an ACP administers Epinephrine 1:10,000. Under modern
resuscitation guidelines, what is the strict provincial cap on standard Epinephrine doses prior to
contacting Medical Control? A) 2 doses B) 3 doses C) 5 doses D) Unlimited doses as long as
the patient is pulseless
● The Answer: C (5 doses)
● Distractor Analysis:
○ A is incorrect: 2 doses cover only 6-10 minutes of an arrest algorithm.
○ B is incorrect: While some consider withholding after 3, the hard cap is 5.
○ D is incorrect: Unlimited Epinephrine causes severe end-organ ischemia.
The Mentor's Analysis: Excessive alpha-adrenergic stimulation from unlimited Epinephrine
severely constricts cerebral microvasculature, decreasing neurologically intact survival.
Professional/Academic Intuition: Epinephrine restores the pulse but starves the brain;
adhere strictly to the 5-dose maximum.
Q5: An ANB crew is managing an EMP palliative patient experiencing severe terminal delirium
and agitation. The family requests the patient remain at home. Which medication is indicated
under the Special Project Palliative Care Medical Directive? A) Salbutamol B) Ketorolac C)
Haloperidol D) Naloxone
● The Answer: C (Haloperidol)
● Distractor Analysis:
○ A is incorrect: Salbutamol is for bronchospasm.
○ B is incorrect: Ketorolac is an NSAID for pain, not delirium.
○ D is incorrect: Naloxone reverses opioids, potentially precipitating severe pain
crisis.
The Mentor's Analysis: Terminal delirium is managed via dopamine antagonism. The
collaborative EMP directive authorizes paramedics to administer Haloperidol to provide dignity
and symptom relief in place. Professional/Academic Intuition: In palliative care, the goal is
symptom control in place, not emergency transport.
Q6: You are preparing to perform a Rapid Sequence Intubation (RSI) on a multi-trauma patient.
The patient has a Shock Index of 1.2 (HR 120, SBP 100). According to the provincial RSI
consensus statement, how MUST the Ketamine induction dose be altered? A) Doubled to
ensure rapid onset of sedation. B) Administered at the standard 2.0 mg/kg dose. C) Reduced by
half to prevent post-intubation hemodynamic collapse. D) Withheld completely in favor of
Midazolam.
● The Answer: C (Reduced by half to prevent post-intubation hemodynamic collapse)
● Distractor Analysis:
○ A is incorrect: Doubling the dose causes profound vasodilation and cardiac arrest.
○ B is incorrect: Standard dosing overwhelms catecholamine-depleted patients.
○ D is incorrect: Midazolam causes even more severe hypotension than Ketamine.
The Mentor's Analysis: High Shock Index (\ge 0.8) indicates catecholamine depletion. Standard
Bank: New Brunswick
EMS/Paramedic
Provincial Protocol
Mastery
PART 0: THE NAVIGATOR
● PART I: THE PRIMER
○ The Prehospital Vanguard: Narrative synthesis of the Ambulance New Brunswick
(ANB) and Paramedic Association of New Brunswick (PANB) operational
frameworks.
○ The "Critical Axioms" Cheat Sheet: Non-negotiable clinical hard-decks for the
2026/2027 operative year.
● PART II: THE ELITE TEST BANK
○ Tier 1 (Questions 1–28) - Foundational Syntax & Application: Protocol
hardlines, pharmacological scope limitations (PCP vs. ACP), and baseline Field
Trauma Triage Guidelines (FTTG).
○ Tier 2 (Questions 29–58) - Complex Application & Simulation: Variable-driven
scenarios assessing Rapid Sequence Intubation (RSI) hemodynamics, S-LAMS
stroke bypass calculations, and Extra-Mural Program (EMP) palliative integration.
○ Tier 3 (Questions 59–88) - Grandmaster Synthesis: High-stakes, multi-system
emergencies integrating refractory cardiac arrest protocols, blood shortage disaster
triage, and severe ethical dilemmas.
PART I: THE PRIMER
Mastering the Ambulance New Brunswick (ANB) clinical directives transcends rote
memorization; it demands algorithmic, instinctual execution under profound physiological and
environmental pressure. This document forges practitioners into elite clinical operators,
translating complex provincial mandates—such as the integrated Extra-Mural Program (EMP)
palliative pathways and the advanced Field Trauma Triage Guidelines (FTTG)—directly into
decisive, high-stakes prehospital intervention.
The paramedic profession in New Brunswick has evolved into a highly autonomous, highly
regulated medical specialty. Governed by the Paramedic Association of New Brunswick (PANB)
,and strictly aligned with the 2024 National Competency Framework for Paramedics (NCFP),
clinicians are mandated to operate as reflective practitioners, accumulating 64 educational
credits annually to maintain rigorous clinical parity with national standards. The system relies on
a stratified scope of practice. Primary Care Paramedics (PCPs) independently manage
advanced airways, initiate intravenous therapy, and administer ten distinct pharmacological
classifications, including sympathomimetics and opioid antagonists. Advanced Care Paramedics
(ACPs) operate as field intensivists, wielding an expanded formulary that includes
antidysrhythmics, benzodiazepines, and advanced procedural capabilities such as Rapid
Sequence Intubation (RSI) and needle thoracostomy.
Recent protocol evolutions have radically altered prehospital algorithms to optimize survivability
and hospital utilization. The implementation of the EMP palliative collaborative directive
empowers paramedics to administer symptom-relief medications (e.g., Haloperidol,
Glycopyrrolate) and refer terminal patients to community care, effectively bypassing the
emergency department. Simultaneously, trauma and neurovascular triage algorithms have
shifted toward definitive care pathways. The FTTG Step 1A criteria require practitioners to
recognize "Immediate Life Threats" and bypass non-surgical Level V facilities in favor of Level I,
II, or III trauma centers. Similarly, the adoption of the S-LAMS assessment tool forces the early
identification of Large Vessel Occlusions (LVO), redirecting patients to Endovascular
Thrombectomy (EVT) centers within a 24-hour window.
The "Critical Axioms" Cheat Sheet
Clinical Domain Actionable Directive & Rationale
Trauma Triage (FTTG) Step 1A Absolute: Physiologic compromise
(GCS < 8, hypotension) supersedes transport
distance. You MUST bypass Level V centers for
Level I, II, or III surgical facilities.
Airway / RSI The Hemodynamic Rule: Pre-intubation shock
index (\ge 0.8) demands resuscitation before
paralysis. Ketamine induction doses must be
halved in uncompensated shock. Target a
post-intubation RASS of -4 and CPOT of 0.
Cardiac Arrest The Catecholamine Cap: Epinephrine
administration in cardiac arrest is strictly
capped at a maximum of 5 doses to prevent
severe end-organ ischemia. For refractory
VF/pVT, initiate a vector change
(anterior/posterior pads).
Palliative / EMP The Dignity Directive: Palliative patients
demonstrating capacity qualify for the "treat and
refer" pathway. Utilize Haloperidol for
delirium/nausea and Glycopyrrolate for terminal
secretions.
Blood Shortage The Red Phase Mandate: During a critical
provincial blood shortage (Red Phase), blood
products are completely withheld from patients
with a systolic BP < 70 mmHg who are
,Clinical Domain Actionable Directive & Rationale
unconscious and unresponsive to fluid
resuscitation.
PART II: THE ELITE TEST BANK
Tier 1 - Foundational Syntax & Application
Q1: Under the New Brunswick Field Trauma Triage Guidelines (FTTG), a patient presents with
an open femur fracture, GCS 14, and a systolic blood pressure of 85 mmHg. Based on Step 1
criteria, what is the MOST APPROPRIATE destination logic? A) Transport to the closest Level V
facility for fluid resuscitation prior to secondary transfer. B) Transport directly to a Level I, II, or III
Trauma Center, bypassing any Level V facility. C) Remain on scene and initiate a mandatory
Epinephrine infusion to correct the hypotension. D) Request air medical transport and refuse
ground transport to preserve clot integrity.
● The Answer: B (Transport directly to a Level I, II, or III Trauma Center, bypassing any
Level V facility)
● Distractor Analysis:
○ A is incorrect: Level V bypass is mandatory for physiological Step 1 criteria
(hypotension).
○ C is incorrect: Vasopressors are contraindicated in hemorrhagic shock.
○ D is incorrect: Ground transport must be initiated if air transport causes definitive
care delays.
The Mentor's Analysis: Hypotension in trauma defines uncompensated hemorrhagic shock.
Level V facilities lack the surgical capability to achieve damage control. Professional/Academic
Intuition: Never transport bleeding physiology to a non-surgical facility.
Q2: According to the PANB standards aligned with the 2024 NCFP, which specific
pharmacological classification is explicitly RESTRICTED from the Primary Care Paramedic
(PCP) scope of practice? A) Antihypoglycemic hormones B) Sympathomimetics C)
Antidysrhythmics D) Opioid antagonists
● The Answer: C (Antidysrhythmics)
● Distractor Analysis:
○ A is incorrect: PCPs administer Glucagon (Antihypoglycemic).
○ B is incorrect: PCPs administer Epinephrine/Salbutamol (Sympathomimetics).
○ D is incorrect: PCPs administer Naloxone (Opioid antagonist).
The Mentor's Analysis: The NCFP stratifies risk. Complex electrical manipulation via
antidysrhythmics (e.g., Amiodarone) requires Advanced Care Paramedic (ACP) intensive
rhythm analysis. Professional/Academic Intuition: PCPs manage the plumbing and the pump
rate; ACPs manage the specific electrical circuitry.
Q3: You are evaluating a patient with sudden onset left-sided weakness. You calculate a Los
Angeles Motor Scale (S-LAMS) score of 5. Based on New York and emerging stroke bypass
protocols integrated globally, what does this score IMMEDIATELY indicate? A) A transient
ischemic attack requiring routine local transport. B) A suspected Large Vessel Occlusion (LVO)
requiring bypass to an Endovascular Thrombectomy (EVT) center. C) A hemorrhagic stroke
requiring an immediate field infusion of Tranexamic Acid (TXA). D) A minor ischemic event
eligible for the treat-and-refer EMP pathway.
● The Answer: B (A suspected Large Vessel Occlusion (LVO) requiring bypass to an
Endovascular Thrombectomy (EVT) center)
, ● Distractor Analysis:
○ A is incorrect: S-LAMS \ge 4 indicates severe, active occlusion.
○ C is incorrect: TXA is not administered for undifferentiated stroke in the field.
○ D is incorrect: EMP pathways are for palliative/chronic conditions, not acute
neurovascular emergencies.
The Mentor's Analysis: The S-LAMS tool specifically predicts the presence of an LVO. Primary
stroke centers can administer thrombolytics, but only EVT centers can mechanically retrieve
large clots. Professional/Academic Intuition: A high LAMS score is the mechanical retrieval
trigger; bypass the primary center if time permits.
Q4: During an adult cardiac arrest, an ACP administers Epinephrine 1:10,000. Under modern
resuscitation guidelines, what is the strict provincial cap on standard Epinephrine doses prior to
contacting Medical Control? A) 2 doses B) 3 doses C) 5 doses D) Unlimited doses as long as
the patient is pulseless
● The Answer: C (5 doses)
● Distractor Analysis:
○ A is incorrect: 2 doses cover only 6-10 minutes of an arrest algorithm.
○ B is incorrect: While some consider withholding after 3, the hard cap is 5.
○ D is incorrect: Unlimited Epinephrine causes severe end-organ ischemia.
The Mentor's Analysis: Excessive alpha-adrenergic stimulation from unlimited Epinephrine
severely constricts cerebral microvasculature, decreasing neurologically intact survival.
Professional/Academic Intuition: Epinephrine restores the pulse but starves the brain;
adhere strictly to the 5-dose maximum.
Q5: An ANB crew is managing an EMP palliative patient experiencing severe terminal delirium
and agitation. The family requests the patient remain at home. Which medication is indicated
under the Special Project Palliative Care Medical Directive? A) Salbutamol B) Ketorolac C)
Haloperidol D) Naloxone
● The Answer: C (Haloperidol)
● Distractor Analysis:
○ A is incorrect: Salbutamol is for bronchospasm.
○ B is incorrect: Ketorolac is an NSAID for pain, not delirium.
○ D is incorrect: Naloxone reverses opioids, potentially precipitating severe pain
crisis.
The Mentor's Analysis: Terminal delirium is managed via dopamine antagonism. The
collaborative EMP directive authorizes paramedics to administer Haloperidol to provide dignity
and symptom relief in place. Professional/Academic Intuition: In palliative care, the goal is
symptom control in place, not emergency transport.
Q6: You are preparing to perform a Rapid Sequence Intubation (RSI) on a multi-trauma patient.
The patient has a Shock Index of 1.2 (HR 120, SBP 100). According to the provincial RSI
consensus statement, how MUST the Ketamine induction dose be altered? A) Doubled to
ensure rapid onset of sedation. B) Administered at the standard 2.0 mg/kg dose. C) Reduced by
half to prevent post-intubation hemodynamic collapse. D) Withheld completely in favor of
Midazolam.
● The Answer: C (Reduced by half to prevent post-intubation hemodynamic collapse)
● Distractor Analysis:
○ A is incorrect: Doubling the dose causes profound vasodilation and cardiac arrest.
○ B is incorrect: Standard dosing overwhelms catecholamine-depleted patients.
○ D is incorrect: Midazolam causes even more severe hypotension than Ketamine.
The Mentor's Analysis: High Shock Index (\ge 0.8) indicates catecholamine depletion. Standard
