Elite Alaska EMS & Paramedic
Protocol Test Bank
PART 0: TABLE OF CONTENTS
● (#part-i-the-preview)
● (#part-ii-the-elite-test-bank)
○ (#tier-1-foundational-syntax--application)
○ (#tier-2-complex-application--simulation)
○ (#tier-3-grandmaster-synthesis)
PART I: THE PREVIEW
Mastering this document bridges the critical gap between foundational prehospital theory and
elite clinical execution within Alaska's austere, high-stakes operational environments. By
internalizing these physiological frameworks and legislative paradigms, you will translate raw
protocol data into decisive, life-saving interventions that align precisely with current state
resuscitation and trauma standards.
The "Critical Axioms" Cheat Sheet
Clinical Domain Critical Axiom / Physiological Source Reference
Protocol
Frostbite Resuscitation Systemic Iloprost (continuous
IV) is indicated for Grade 2–4
extremity frostbite up to 72
hours post-rewarming to inhibit
platelet aggregation; systemic
thrombolytics are restricted to
Grade 3–4 injuries within 24
hours.
Analgesia Synergy Ban The co-administration of
Fentanyl and Ketamine for
acute pain management is
strictly prohibited. Utilize
Ketorolac (15mg IV/IM) as the
primary first-line agent for
minor-to-moderate pain barring
contraindications.
,Clinical Domain Critical Axiom / Physiological Source Reference
Protocol
Burn Triage Mandate Early, direct transfer to
Harborview Medical Center is
absolute for pediatric
full-thickness burns >10%
TBSA and adult full-thickness
burns >30% TBSA, anticipating
massive fluid shifts.
POLST Authority Alaska POLST supersedes the
legacy Comfort One program.
Selecting "Comfort-focused
Treatments" explicitly prohibits
hospital transfer unless
symptom control (e.g., severe
pain, hemorrhage)
catastrophically fails in the
current setting.
AHA 2025 Cardiac Dynamics Atrial fibrillation/flutter requires
a higher first-shock energy
(≥200 J) to terminate chaotic
wavelets; pediatric cardiac
arrest mandates a 15:2
compression-to-ventilation ratio
without an advanced airway to
mitigate hypoxia.
PART II: THE ELITE TEST BANK
Tier 1: Foundational Syntax & Application
Q1: An adult patient presents with deep extremity frostbite exhibiting cyanotic, woody tissue
without clear blisters. Rapid rewarming is completed. Based on the 2025/2026 Alaska Acute
Frostbite Management Guidelines, which pharmacological intervention is MOST
APPROPRIATE if the patient is 12 hours post-rewarming? A) Intramuscular epinephrine to
promote peripheral vasoconstriction B) Systemic thrombolytics and iloprost continuous IV
infusion C) Catheter-directed thrombolytics only D) Subcutaneous enoxaparin and strict fluid
restriction
● The Answer: B (Systemic thrombolytics and iloprost continuous IV infusion)
● Distractor Analysis:
○ A is incorrect: Epinephrine induces intense vasoconstriction, which catastrophically
worsens tissue ischemia in frostbite microcirculation.
○ C is incorrect: Systemic administration is explicitly supported over catheter-directed
thrombolysis in Alaska due to remote geographical and medevac transport
limitations.
○ D is incorrect: Hydration is critical to prevent hypovolemia and vascular stasis;
enoxaparin is not the primary indicated fibrinolytic for acute frostbite tissue salvage.
The Mentor's Analysis: Grade 3 and 4 frostbite require aggressive vessel dilation and clot
, lysis. When facing severe deep tissue freezing within the 24-hour window, the immediate priority
is salvaging the digit via dual therapy. By utilizing systemic thrombolytics and iloprost, you
bypass the common novice trap of relying solely on passive rewarming while micro-thrombi
destroy the distal capillary beds. Professional/Academic Intuition: Grade 3/4 frostbite within
24 hours demands systemic thrombolytics; Iloprost extends the salvage window up to 72
hours.
Q2: A paramedic evaluates a patient's newly signed Alaska POLST form. Section A indicates
"YES CPR" but Section B indicates "Comfort-focused Treatments." What is the MOST
ACCURATE clinical conclusion? A) The form is valid; proceed with comfort measures and
intubate if pulse is lost. B) The form is legally invalid; "YES CPR" mandates the selection of "Full
Treatments" in Section B. C) The form defaults to Comfort One legacy protocols. D) The
provider must contact online medical control to void the document.
● The Answer: B (The form is legally invalid; "YES CPR" mandates the selection of "Full
Treatments" in Section B.)
● Distractor Analysis:
○ A is incorrect: You cannot have a valid order for chest compressions while
simultaneously restricting interventions to strictly palliative comfort measures prior
to the arrest.
○ C is incorrect: The POLST form does not default back to Comfort One; Comfort
One is actively being phased out statewide.
○ D is incorrect: The form is fundamentally invalid due to a logical contradiction
governed by state legislative mandate, requiring standard full resuscitation default;
it does not require explicit voiding by a medical director.
The Mentor's Analysis: Advance directives must maintain logical clinical consistency to be
legally actionable. When facing contradictory POLST orders, the immediate priority is
recognizing form invalidity. By utilizing the default full-treatment doctrine, you bypass the novice
trap of under-resuscitating a viable patient based on a legally flawed document.
Professional/Academic Intuition: If a patient desires CPR, they inherently consent to the
full spectrum of pre-arrest life-sustaining treatments.
Q3: A 6-year-old child weighing 20 kg requires synchronized cardioversion for unstable
supraventricular tachycardia (SVT). According to the AHA 2025 and pediatric protocols, what is
the FIRST appropriate energy dose? A) 10 Joules B) 20 Joules C) 40 Joules D) 100 Joules
● The Answer: B (20 Joules)
● Distractor Analysis:
○ A is incorrect: 10 J represents 0.5 J/kg, which is a sub-therapeutic dose that will fail
to capture and terminate the re-entrant tachycardia.
○ C is incorrect: 40 J represents 2 J/kg, which is the initial defibrillation dose for
pulseless rhythms, not the synchronized cardioversion dose.
○ D is incorrect: 100 J is an adult dosage parameter and would cause significant
myocardial stunning in a 20 kg child.
The Mentor's Analysis: Pediatric electrical therapy is strictly weight-based to prevent
myocardial damage. When facing unstable pediatric tachyarrhythmias, the immediate priority is
precise energy delivery calibrated to body mass. By utilizing 1 J/kg for initial synchronized
cardioversion, you bypass the novice trap of confusing defibrillation and cardioversion
escalation algorithms. Professional/Academic Intuition: Pediatric cardioversion begins at 1
J/kg; pediatric defibrillation begins at 2 J/kg.
Q4: Under the Alaska EMS Scope of Practice, an EMT utilizing a telemetric monitoring device or
manual defibrillator possesses an "X*" notation next to the skill. What does this MOST
Protocol Test Bank
PART 0: TABLE OF CONTENTS
● (#part-i-the-preview)
● (#part-ii-the-elite-test-bank)
○ (#tier-1-foundational-syntax--application)
○ (#tier-2-complex-application--simulation)
○ (#tier-3-grandmaster-synthesis)
PART I: THE PREVIEW
Mastering this document bridges the critical gap between foundational prehospital theory and
elite clinical execution within Alaska's austere, high-stakes operational environments. By
internalizing these physiological frameworks and legislative paradigms, you will translate raw
protocol data into decisive, life-saving interventions that align precisely with current state
resuscitation and trauma standards.
The "Critical Axioms" Cheat Sheet
Clinical Domain Critical Axiom / Physiological Source Reference
Protocol
Frostbite Resuscitation Systemic Iloprost (continuous
IV) is indicated for Grade 2–4
extremity frostbite up to 72
hours post-rewarming to inhibit
platelet aggregation; systemic
thrombolytics are restricted to
Grade 3–4 injuries within 24
hours.
Analgesia Synergy Ban The co-administration of
Fentanyl and Ketamine for
acute pain management is
strictly prohibited. Utilize
Ketorolac (15mg IV/IM) as the
primary first-line agent for
minor-to-moderate pain barring
contraindications.
,Clinical Domain Critical Axiom / Physiological Source Reference
Protocol
Burn Triage Mandate Early, direct transfer to
Harborview Medical Center is
absolute for pediatric
full-thickness burns >10%
TBSA and adult full-thickness
burns >30% TBSA, anticipating
massive fluid shifts.
POLST Authority Alaska POLST supersedes the
legacy Comfort One program.
Selecting "Comfort-focused
Treatments" explicitly prohibits
hospital transfer unless
symptom control (e.g., severe
pain, hemorrhage)
catastrophically fails in the
current setting.
AHA 2025 Cardiac Dynamics Atrial fibrillation/flutter requires
a higher first-shock energy
(≥200 J) to terminate chaotic
wavelets; pediatric cardiac
arrest mandates a 15:2
compression-to-ventilation ratio
without an advanced airway to
mitigate hypoxia.
PART II: THE ELITE TEST BANK
Tier 1: Foundational Syntax & Application
Q1: An adult patient presents with deep extremity frostbite exhibiting cyanotic, woody tissue
without clear blisters. Rapid rewarming is completed. Based on the 2025/2026 Alaska Acute
Frostbite Management Guidelines, which pharmacological intervention is MOST
APPROPRIATE if the patient is 12 hours post-rewarming? A) Intramuscular epinephrine to
promote peripheral vasoconstriction B) Systemic thrombolytics and iloprost continuous IV
infusion C) Catheter-directed thrombolytics only D) Subcutaneous enoxaparin and strict fluid
restriction
● The Answer: B (Systemic thrombolytics and iloprost continuous IV infusion)
● Distractor Analysis:
○ A is incorrect: Epinephrine induces intense vasoconstriction, which catastrophically
worsens tissue ischemia in frostbite microcirculation.
○ C is incorrect: Systemic administration is explicitly supported over catheter-directed
thrombolysis in Alaska due to remote geographical and medevac transport
limitations.
○ D is incorrect: Hydration is critical to prevent hypovolemia and vascular stasis;
enoxaparin is not the primary indicated fibrinolytic for acute frostbite tissue salvage.
The Mentor's Analysis: Grade 3 and 4 frostbite require aggressive vessel dilation and clot
, lysis. When facing severe deep tissue freezing within the 24-hour window, the immediate priority
is salvaging the digit via dual therapy. By utilizing systemic thrombolytics and iloprost, you
bypass the common novice trap of relying solely on passive rewarming while micro-thrombi
destroy the distal capillary beds. Professional/Academic Intuition: Grade 3/4 frostbite within
24 hours demands systemic thrombolytics; Iloprost extends the salvage window up to 72
hours.
Q2: A paramedic evaluates a patient's newly signed Alaska POLST form. Section A indicates
"YES CPR" but Section B indicates "Comfort-focused Treatments." What is the MOST
ACCURATE clinical conclusion? A) The form is valid; proceed with comfort measures and
intubate if pulse is lost. B) The form is legally invalid; "YES CPR" mandates the selection of "Full
Treatments" in Section B. C) The form defaults to Comfort One legacy protocols. D) The
provider must contact online medical control to void the document.
● The Answer: B (The form is legally invalid; "YES CPR" mandates the selection of "Full
Treatments" in Section B.)
● Distractor Analysis:
○ A is incorrect: You cannot have a valid order for chest compressions while
simultaneously restricting interventions to strictly palliative comfort measures prior
to the arrest.
○ C is incorrect: The POLST form does not default back to Comfort One; Comfort
One is actively being phased out statewide.
○ D is incorrect: The form is fundamentally invalid due to a logical contradiction
governed by state legislative mandate, requiring standard full resuscitation default;
it does not require explicit voiding by a medical director.
The Mentor's Analysis: Advance directives must maintain logical clinical consistency to be
legally actionable. When facing contradictory POLST orders, the immediate priority is
recognizing form invalidity. By utilizing the default full-treatment doctrine, you bypass the novice
trap of under-resuscitating a viable patient based on a legally flawed document.
Professional/Academic Intuition: If a patient desires CPR, they inherently consent to the
full spectrum of pre-arrest life-sustaining treatments.
Q3: A 6-year-old child weighing 20 kg requires synchronized cardioversion for unstable
supraventricular tachycardia (SVT). According to the AHA 2025 and pediatric protocols, what is
the FIRST appropriate energy dose? A) 10 Joules B) 20 Joules C) 40 Joules D) 100 Joules
● The Answer: B (20 Joules)
● Distractor Analysis:
○ A is incorrect: 10 J represents 0.5 J/kg, which is a sub-therapeutic dose that will fail
to capture and terminate the re-entrant tachycardia.
○ C is incorrect: 40 J represents 2 J/kg, which is the initial defibrillation dose for
pulseless rhythms, not the synchronized cardioversion dose.
○ D is incorrect: 100 J is an adult dosage parameter and would cause significant
myocardial stunning in a 20 kg child.
The Mentor's Analysis: Pediatric electrical therapy is strictly weight-based to prevent
myocardial damage. When facing unstable pediatric tachyarrhythmias, the immediate priority is
precise energy delivery calibrated to body mass. By utilizing 1 J/kg for initial synchronized
cardioversion, you bypass the novice trap of confusing defibrillation and cardioversion
escalation algorithms. Professional/Academic Intuition: Pediatric cardioversion begins at 1
J/kg; pediatric defibrillation begins at 2 J/kg.
Q4: Under the Alaska EMS Scope of Practice, an EMT utilizing a telemetric monitoring device or
manual defibrillator possesses an "X*" notation next to the skill. What does this MOST
