SANTA CLARA COUNTY EMS PARAMEDIC
PROTOCOL EXAM 2026/2027 COMPLETE
QUESTION BANK VERIFIED ANSWERS &
DETAILED RATIONALES
Question 1
A 65-year-old male is experiencing a severe, crushing chest injury with a
confirmed ST-segment elevation myocardial infarction (STEMI) on a 12-lead
ECG. The patient is hypotensive with a blood pressure of 82/44 mmHg and
signs of cardiogenic shock. Which of the following standard ischemia
interventions is strictly contraindicated for this patient under Santa Clara
County protocols?
A. Aspirin 324 mg chewed
B. Fentanyl 50 mcg IV
C. Nitroglycerin 0.4 mg SL
D. Normal Saline 250 mL fluid bolus
,VERIFIED ANSWER: C. Nitroglycerin 0.4 mg SL
EXPLANATION: Nitroglycerin is a potent venodilator that decreases preload.
Under Santa Clara County protocols, it is strictly contraindicated in patients
with a systolic blood pressure below 90 mmHg, as well as in patients with
suspected right ventricular infarction or recent phosphodiesterase-5 inhibitor
use, as it can cause catastrophic cardiovascular collapse.
Question 2
You are transporting a 4-year-old female in severe respiratory distress due to
suspected croup. She has audible stridor at rest and intercostal retractions.
According to pediatric respiratory distress protocols, what is the correct dosage
and route for Epinephrine administration?
A. Epinephrine 1:1,000, 0.3 mg IM
B. Epinephrine 1:1,000, 5 mL (5 mg) nebulized
C. Epinephrine 1:10,000, 0.1 mg/kg IV
D. Epinephrine 1:1,000, 0.01 mg/kg IM
VERIFIED ANSWER: B. Epinephrine 1:1,000, 5 mL (5 mg) nebulized
EXPLANATION: For pediatric patients with severe respiratory distress
presenting with stridor at rest (suspected croup), Santa Clara County
protocols mandate the administration of 5 mL of Epinephrine 1:1,000 via
nebulizer. This directly targets upper airway edema via local vasoconstriction.
Question 3
While on the scene of a multi-vehicle collision, you identify a patient who is
unresponsive, breathing at a rate of 8 breaths per minute, and lacks a radial
pulse. According to the Simple Triage and Rapid Treatment (START) algorithm
utilized during an MCI, what color tag should this patient receive?
A. Green
B. Yellow
,C. Red
D. Black
VERIFIED ANSWER: C. Red
EXPLANATION: Under the START triage framework, any patient who fails
the respiratory parameters (breathing less than 10 or more than 30 breaths
per minute), has altered mental status, or has absent radial pulses/capillary
refill over 2 seconds is classified as an immediate priority and receives a Red
tag.
Question 4
A paramedic is preparing to perform endotracheal intubation on an adult patient.
According to county quality assurance standards, what is the maximum number
of intubation attempts allowed per paramedic before an alternative airway must
be utilized?
A. One attempt
B. Two attempts
C. Three attempts
D. Four attempts
VERIFIED ANSWER: B. Two attempts
EXPLANATION: To minimize hypoxia and airway trauma, Santa Clara
County EMS protocols limit a single paramedic to a maximum of two
intubation attempts. If unsuccessful after two attempts, the provider must
transition to a supraglottic airway or bag-valve-mask ventilation.
Question 5
You are treating an adult patient in status epilepticus. The patient has been
actively seizing for over 7 minutes without a waking interval. You have
established IV access. What is the preferred first-line medication and
intravenous dosage under county protocol?
, A. Midazolam 5 mg IV
B. Midazolam 10 mg IM
C. Lorazepam 4 mg IV
D. Diazepam 5 mg IV
VERIFIED ANSWER: A. Midazolam 5 mg IV
EXPLANATION: For an adult patient in active status epilepticus with
established IV access, the county protocol dictates Midazolam 5 mg IV as the
initial preferred choice. If IV access is unavailable, Midazolam 10 mg IM is
the preferred route.
Question 6
During a routine Interfacility Transport (IFT), a paramedic needs to give a
clinical update to the receiving hospital for a stable patient who requires no
special alerts. What is the approved method of communication to execute this
standard ringdown?
A. Zone B HOSPITAL radio channel
B. County command radio channel
C. Cellular phone or dedicated rig telephone
D. Web-based electronic PCR messaging
VERIFIED ANSWER: C. Cellular phone or dedicated rig telephone
EXPLANATION: To preserve radio bandwidth for critical emergencies,
county protocols state that all routine, non-alert hospital notifications and
IFT updates must be conducted via commercial cellular phones or landlines
rather than the emergency radio system.
Question 7
A 29-year-old female has sustained deep partial-thickness burns to her entire
anterior torso and the entire front of both legs. Using the Rule of Nines, what is
the estimated total body surface area (TBSA) burned?
PROTOCOL EXAM 2026/2027 COMPLETE
QUESTION BANK VERIFIED ANSWERS &
DETAILED RATIONALES
Question 1
A 65-year-old male is experiencing a severe, crushing chest injury with a
confirmed ST-segment elevation myocardial infarction (STEMI) on a 12-lead
ECG. The patient is hypotensive with a blood pressure of 82/44 mmHg and
signs of cardiogenic shock. Which of the following standard ischemia
interventions is strictly contraindicated for this patient under Santa Clara
County protocols?
A. Aspirin 324 mg chewed
B. Fentanyl 50 mcg IV
C. Nitroglycerin 0.4 mg SL
D. Normal Saline 250 mL fluid bolus
,VERIFIED ANSWER: C. Nitroglycerin 0.4 mg SL
EXPLANATION: Nitroglycerin is a potent venodilator that decreases preload.
Under Santa Clara County protocols, it is strictly contraindicated in patients
with a systolic blood pressure below 90 mmHg, as well as in patients with
suspected right ventricular infarction or recent phosphodiesterase-5 inhibitor
use, as it can cause catastrophic cardiovascular collapse.
Question 2
You are transporting a 4-year-old female in severe respiratory distress due to
suspected croup. She has audible stridor at rest and intercostal retractions.
According to pediatric respiratory distress protocols, what is the correct dosage
and route for Epinephrine administration?
A. Epinephrine 1:1,000, 0.3 mg IM
B. Epinephrine 1:1,000, 5 mL (5 mg) nebulized
C. Epinephrine 1:10,000, 0.1 mg/kg IV
D. Epinephrine 1:1,000, 0.01 mg/kg IM
VERIFIED ANSWER: B. Epinephrine 1:1,000, 5 mL (5 mg) nebulized
EXPLANATION: For pediatric patients with severe respiratory distress
presenting with stridor at rest (suspected croup), Santa Clara County
protocols mandate the administration of 5 mL of Epinephrine 1:1,000 via
nebulizer. This directly targets upper airway edema via local vasoconstriction.
Question 3
While on the scene of a multi-vehicle collision, you identify a patient who is
unresponsive, breathing at a rate of 8 breaths per minute, and lacks a radial
pulse. According to the Simple Triage and Rapid Treatment (START) algorithm
utilized during an MCI, what color tag should this patient receive?
A. Green
B. Yellow
,C. Red
D. Black
VERIFIED ANSWER: C. Red
EXPLANATION: Under the START triage framework, any patient who fails
the respiratory parameters (breathing less than 10 or more than 30 breaths
per minute), has altered mental status, or has absent radial pulses/capillary
refill over 2 seconds is classified as an immediate priority and receives a Red
tag.
Question 4
A paramedic is preparing to perform endotracheal intubation on an adult patient.
According to county quality assurance standards, what is the maximum number
of intubation attempts allowed per paramedic before an alternative airway must
be utilized?
A. One attempt
B. Two attempts
C. Three attempts
D. Four attempts
VERIFIED ANSWER: B. Two attempts
EXPLANATION: To minimize hypoxia and airway trauma, Santa Clara
County EMS protocols limit a single paramedic to a maximum of two
intubation attempts. If unsuccessful after two attempts, the provider must
transition to a supraglottic airway or bag-valve-mask ventilation.
Question 5
You are treating an adult patient in status epilepticus. The patient has been
actively seizing for over 7 minutes without a waking interval. You have
established IV access. What is the preferred first-line medication and
intravenous dosage under county protocol?
, A. Midazolam 5 mg IV
B. Midazolam 10 mg IM
C. Lorazepam 4 mg IV
D. Diazepam 5 mg IV
VERIFIED ANSWER: A. Midazolam 5 mg IV
EXPLANATION: For an adult patient in active status epilepticus with
established IV access, the county protocol dictates Midazolam 5 mg IV as the
initial preferred choice. If IV access is unavailable, Midazolam 10 mg IM is
the preferred route.
Question 6
During a routine Interfacility Transport (IFT), a paramedic needs to give a
clinical update to the receiving hospital for a stable patient who requires no
special alerts. What is the approved method of communication to execute this
standard ringdown?
A. Zone B HOSPITAL radio channel
B. County command radio channel
C. Cellular phone or dedicated rig telephone
D. Web-based electronic PCR messaging
VERIFIED ANSWER: C. Cellular phone or dedicated rig telephone
EXPLANATION: To preserve radio bandwidth for critical emergencies,
county protocols state that all routine, non-alert hospital notifications and
IFT updates must be conducted via commercial cellular phones or landlines
rather than the emergency radio system.
Question 7
A 29-year-old female has sustained deep partial-thickness burns to her entire
anterior torso and the entire front of both legs. Using the Rule of Nines, what is
the estimated total body surface area (TBSA) burned?
