SANTA CLARA COUNTY EMS
PARAMEDIC PROTOCOL PATIENT CARE
PROCEDURES FINAL REVIEW PACK
COMPLETE CORRECT ANSWERSS
Section 1: Stroke and Neurological Emergencies (Questions 1-10)
1. A patient presents with acute onset of unilateral weakness, facial droop, and
slurred speech. The stroke scale is positive. Onset time is 2 hours ago. The patient
takes apixaban. Which action is most critical before transport to a stroke center?
A. Administer aspirin 324 mg orally
B. Determine last known well time beyond 4.5 hours
C. Assess blood glucose and obtain glucose level
D. Administer 1 liter normal saline bolus
Correct answers: C. Assess blood glucose and obtain glucose level
Rationale: Hypoglycemia can mimic stroke symptoms, so assessing and correcting
glucose is essential before activating stroke protocols. Aspirin is contraindicated if the
patient is on apixaban and may be a candidate for thrombolytics (risk of bleeding).
Determining last known well time is important but not the most critical immediate
action. Fluid bolus is not indicated unless hypotensive .
2. What is the Santa Clara County stroke screening acronym and what does each
letter represent?
Correct answers: G-F-A-S-T
, • G: Gaze deviation
• F: Facial droop
• A: Arm or leg weakness/drift
• S: Speech difficulties
• T: Time last known well (no point value)
Rationale: The G-F-A-S-T stroke screening tool is used to identify potential stroke
patients. Gaze deviation, facial asymmetry, arm/leg weakness, and speech difficulties are
each scored (0-1 point). A total of four points triggers transport to a Comprehensive
Stroke Center. Time last known well is documented but not scored .
3. How many positive findings on the Santa Clara County stroke scale are required
to transport a patient on a "Stroke Alert"?
Correct answers: 1 (any one positive finding)
Rationale: A single positive finding on the G-F-A-S-T stroke screening is sufficient to
activate a stroke alert. The total score determines destination: 4 points = Comprehensive
Stroke Center; 3 or fewer points = closest Stroke Center (Comprehensive or Primary) .
4. Which hospitals in Santa Clara County are designated as Comprehensive Stroke
Centers?
Correct answers: El Camino Hospital of Mountain View, Good Samaritan Hospital,
Regional Medical Center of San Jose, and Stanford University Medical Center.
, 5. Which hospital in Santa Clara County is NOT a stroke center?
A. El Camino Hospital
B. Good Samaritan Hospital
C. VA Palo Alto
D. Regional Medical Center
Correct answers: C. VA Palo Alto
6. A paramedic is assessing a patient with suspected stroke. The patient's blood
glucose is 45 mg/dL. What is the appropriate next action per protocol?
Correct answers: Treat hypoglycemia per Policy 700-A03. For BLS: If BGL is 80 mg/dL or
less and patient can swallow, administer oral glucose (at least 25g), repeat once after 15
minutes if no improvement. For ALS: Establish vascular access, administer D10% IV,
repeat boluses as needed, or Glucagon 1mg IM if no IV access. If BGL is less than 60
mg/dL, withhold oral glucose due to dysphagia risk .
7. The Cincinnati Prehospital Stroke Scale is positive in a patient with onset of
symptoms 2 hours ago. What is the immediate priority?
Correct answers: Assess blood glucose and obtain glucose level, as hypoglycemia can
mimic stroke symptoms.
8. A stroke patient takes apixaban. Why is aspirin contraindicated?
PARAMEDIC PROTOCOL PATIENT CARE
PROCEDURES FINAL REVIEW PACK
COMPLETE CORRECT ANSWERSS
Section 1: Stroke and Neurological Emergencies (Questions 1-10)
1. A patient presents with acute onset of unilateral weakness, facial droop, and
slurred speech. The stroke scale is positive. Onset time is 2 hours ago. The patient
takes apixaban. Which action is most critical before transport to a stroke center?
A. Administer aspirin 324 mg orally
B. Determine last known well time beyond 4.5 hours
C. Assess blood glucose and obtain glucose level
D. Administer 1 liter normal saline bolus
Correct answers: C. Assess blood glucose and obtain glucose level
Rationale: Hypoglycemia can mimic stroke symptoms, so assessing and correcting
glucose is essential before activating stroke protocols. Aspirin is contraindicated if the
patient is on apixaban and may be a candidate for thrombolytics (risk of bleeding).
Determining last known well time is important but not the most critical immediate
action. Fluid bolus is not indicated unless hypotensive .
2. What is the Santa Clara County stroke screening acronym and what does each
letter represent?
Correct answers: G-F-A-S-T
, • G: Gaze deviation
• F: Facial droop
• A: Arm or leg weakness/drift
• S: Speech difficulties
• T: Time last known well (no point value)
Rationale: The G-F-A-S-T stroke screening tool is used to identify potential stroke
patients. Gaze deviation, facial asymmetry, arm/leg weakness, and speech difficulties are
each scored (0-1 point). A total of four points triggers transport to a Comprehensive
Stroke Center. Time last known well is documented but not scored .
3. How many positive findings on the Santa Clara County stroke scale are required
to transport a patient on a "Stroke Alert"?
Correct answers: 1 (any one positive finding)
Rationale: A single positive finding on the G-F-A-S-T stroke screening is sufficient to
activate a stroke alert. The total score determines destination: 4 points = Comprehensive
Stroke Center; 3 or fewer points = closest Stroke Center (Comprehensive or Primary) .
4. Which hospitals in Santa Clara County are designated as Comprehensive Stroke
Centers?
Correct answers: El Camino Hospital of Mountain View, Good Samaritan Hospital,
Regional Medical Center of San Jose, and Stanford University Medical Center.
, 5. Which hospital in Santa Clara County is NOT a stroke center?
A. El Camino Hospital
B. Good Samaritan Hospital
C. VA Palo Alto
D. Regional Medical Center
Correct answers: C. VA Palo Alto
6. A paramedic is assessing a patient with suspected stroke. The patient's blood
glucose is 45 mg/dL. What is the appropriate next action per protocol?
Correct answers: Treat hypoglycemia per Policy 700-A03. For BLS: If BGL is 80 mg/dL or
less and patient can swallow, administer oral glucose (at least 25g), repeat once after 15
minutes if no improvement. For ALS: Establish vascular access, administer D10% IV,
repeat boluses as needed, or Glucagon 1mg IM if no IV access. If BGL is less than 60
mg/dL, withhold oral glucose due to dysphagia risk .
7. The Cincinnati Prehospital Stroke Scale is positive in a patient with onset of
symptoms 2 hours ago. What is the immediate priority?
Correct answers: Assess blood glucose and obtain glucose level, as hypoglycemia can
mimic stroke symptoms.
8. A stroke patient takes apixaban. Why is aspirin contraindicated?
