Clallam County EMS Protocols Exam
With Practice Questions And Correct
Answers (Verified A
1. A patient with severe respiratory distress from an asthma exacerbation has received
three consecutive albuterol treatments with minimal improvement. According to
Clallam County EMS protocols, which intervention is most appropriate next?
A. Administer intramuscular epinephrine 0.3 mg (1:1000).
B. Initiate continuous positive airway pressure (CPAP) with inline albuterol.
C. Administer intravenous magnesium sulfate 2 g over 10 minutes.
D. Perform endotracheal intubation with rapid sequence induction.
Answer: B. Initiate continuous positive airway pressure (CPAP) with inline albuterol.
Rationale: Clallam County protocols prioritize CPAP for severe asthma unresponsive to
initial bronchodilators, as it reduces work of breathing and improves delivery of inhaled
medications. IM epinephrine is reserved for anaphylaxis, magnesium is not a first-line EMS
intervention in this protocol, and intubation is considered only after CPAP failure.
2. In a patient with suspected opioid overdose presenting with agonal respirations and
a palpable radial pulse, which sequence of interventions aligns with Clallam County
EMS protocols?
A. Administer naloxone 2 mg intranasal, then assist ventilations with a bag-valve-mask.
B. Begin chest compressions immediately, then administer naloxone 0.4 mg IV.
C. Insert a supraglottic airway, then administer naloxone 0.4 mg IM.
D. Apply high-flow oxygen, then administer naloxone 2 mg IV push.
Answer: A. Administer naloxone 2 mg intranasal, then assist ventilations with a
bag-valve-mask.
Rationale: Clallam County protocols emphasize airway and ventilation support first, with
intranasal naloxone as the preferred route for suspected opioid overdose. Chest
compressions are not indicated if a pulse is present, and IV access may delay treatment in
the prehospital setting.
Page 1 of 75
,3. A patient with a suspected cervical spine injury after a fall requires airway
management. Which technique is specifically recommended by Clallam County EMS
protocols to minimize spinal movement?
A. Orotracheal intubation with manual in-line stabilization.
B. Nasotracheal intubation with the head in a neutral position.
C. Supraglottic airway insertion with the head elevated 30 degrees.
D. Cricothyrotomy with the neck in hyperextension.
Answer: A. Orotracheal intubation with manual in-line stabilization.
Rationale: Clallam County protocols endorse orotracheal intubation with manual in-line
stabilization as the preferred method for cervical spine protection during airway
management. Nasotracheal intubation is contraindicated in apneic patients, supraglottic
airways do not definitively secure the airway, and cricothyrotomy is a rescue technique not
first-line.
4. A patient with STEMI on the 12-lead ECG is 45 minutes from the nearest
PCI-capable hospital. According to Clallam County EMS protocols, which action is
most appropriate?
A. Administer fibrinolytic therapy if symptom onset is within 12 hours and no
contraindications.
B. Transport directly to the PCI center with prehospital activation, regardless of transport
time.
C. Divert to the closest non-PCI hospital for stabilization and subsequent transfer.
D. Administer aspirin and nitroglycerin, then reassess for transport decision.
Answer: B. Transport directly to the PCI center with prehospital activation,
regardless of transport time.
Rationale: Clallam County protocols prioritize direct transport to a PCI-capable facility
when prehospital activation is possible, even with longer transport times, as primary PCI is
superior to fibrinolysis when achievable within 120 minutes. Fibrinolysis is not
recommended when timely PCI is available, and diversion to a non-PCI hospital delays
definitive care.
Page 2 of 75
,5. A patient with a traumatic amputation of the left arm is bleeding profusely despite
direct pressure. Which Clallam County EMS protocol intervention is indicated next?
A. Apply a tourniquet proximal to the amputation site.
B. Elevate the extremity and apply a pressure dressing.
C. Administer tranexamic acid 1 g IV over 10 minutes.
D. Pack the wound with hemostatic gauze and apply direct pressure.
Answer: A. Apply a tourniquet proximal to the amputation site.
Rationale: Clallam County protocols recommend tourniquet application for
life-threatening extremity hemorrhage not controlled by direct pressure. Elevation and
pressure dressings are ineffective for arterial bleeding, tranexamic acid is adjunctive but
not immediate hemorrhage control, and hemostatic gauze is used for junctional wounds.
6. A patient with severe sepsis presents with hypotension and tachycardia. According
to Clallam County EMS protocols, which fluid resuscitation strategy is recommended?
A. Administer 500 mL boluses of 0.9% NaCl, reassessing after each bolus.
B. Administer 2 L of lactated Ringer's solution rapidly over 15 minutes.
C. Administer 1 L of 0.9% NaCl over 30 minutes, then start norepinephrine.
D. Administer 250 mL boluses of 0.9% NaCl, reassessing after each bolus.
Answer: A. Administer 500 mL boluses of 0.9% NaCl, reassessing after each bolus.
Rationale: Clallam County protocols recommend cautious fluid resuscitation with 500 mL
boluses of isotonic crystalloid in sepsis, with frequent reassessment to avoid fluid overload.
Rapid 2 L boluses are not advised in the prehospital setting, and vasopressors are initiated
only after adequate fluid resuscitation.
Page 3 of 75
, 7. A patient with a suspected tension pneumothorax presents with severe dyspnea,
unilateral absent breath sounds, and hypotension. Which Clallam County EMS
protocol intervention is indicated?
A. Needle decompression at the second intercostal space, midclavicular line.
B. Needle decompression at the fifth intercostal space, anterior axillary line.
C. Application of a three-sided occlusive dressing.
D. Positive pressure ventilation with a bag-valve-mask.
Answer: A. Needle decompression at the second intercostal space, midclavicular line.
Rationale: Clallam County protocols specify needle decompression at the second
intercostal space, midclavicular line, for tension pneumothorax. The fifth intercostal space
is an alternative but not the primary site in this protocol, occlusive dressings are for open
pneumothorax, and positive pressure ventilation can worsen tension pneumothorax.
8. Which of the following best describes the Clallam County EMS protocol for
termination of resuscitation (TOR) in out-of-hospital cardiac arrest?
A. TOR may be considered after 20 minutes of ACLS without ROSC, asystole
throughout, and no reversible causes.
B. TOR is never permitted; all patients must be transported to the hospital.
C. TOR requires online medical control approval after 30 minutes of ACLS.
D. TOR may be considered after 10 minutes of ACLS if the patient remains in asystole.
Answer: A. TOR may be considered after 20 minutes of ACLS without ROSC,
asystole throughout, and no reversible causes.
Rationale: Clallam County protocols allow TOR after 20 minutes of ACLS without ROSC,
persistent asystole, and exclusion of reversible causes, consistent with national guidelines.
TOR is not prohibited, online approval is not mandated, and 10 minutes is insufficient.
Page 4 of 75
With Practice Questions And Correct
Answers (Verified A
1. A patient with severe respiratory distress from an asthma exacerbation has received
three consecutive albuterol treatments with minimal improvement. According to
Clallam County EMS protocols, which intervention is most appropriate next?
A. Administer intramuscular epinephrine 0.3 mg (1:1000).
B. Initiate continuous positive airway pressure (CPAP) with inline albuterol.
C. Administer intravenous magnesium sulfate 2 g over 10 minutes.
D. Perform endotracheal intubation with rapid sequence induction.
Answer: B. Initiate continuous positive airway pressure (CPAP) with inline albuterol.
Rationale: Clallam County protocols prioritize CPAP for severe asthma unresponsive to
initial bronchodilators, as it reduces work of breathing and improves delivery of inhaled
medications. IM epinephrine is reserved for anaphylaxis, magnesium is not a first-line EMS
intervention in this protocol, and intubation is considered only after CPAP failure.
2. In a patient with suspected opioid overdose presenting with agonal respirations and
a palpable radial pulse, which sequence of interventions aligns with Clallam County
EMS protocols?
A. Administer naloxone 2 mg intranasal, then assist ventilations with a bag-valve-mask.
B. Begin chest compressions immediately, then administer naloxone 0.4 mg IV.
C. Insert a supraglottic airway, then administer naloxone 0.4 mg IM.
D. Apply high-flow oxygen, then administer naloxone 2 mg IV push.
Answer: A. Administer naloxone 2 mg intranasal, then assist ventilations with a
bag-valve-mask.
Rationale: Clallam County protocols emphasize airway and ventilation support first, with
intranasal naloxone as the preferred route for suspected opioid overdose. Chest
compressions are not indicated if a pulse is present, and IV access may delay treatment in
the prehospital setting.
Page 1 of 75
,3. A patient with a suspected cervical spine injury after a fall requires airway
management. Which technique is specifically recommended by Clallam County EMS
protocols to minimize spinal movement?
A. Orotracheal intubation with manual in-line stabilization.
B. Nasotracheal intubation with the head in a neutral position.
C. Supraglottic airway insertion with the head elevated 30 degrees.
D. Cricothyrotomy with the neck in hyperextension.
Answer: A. Orotracheal intubation with manual in-line stabilization.
Rationale: Clallam County protocols endorse orotracheal intubation with manual in-line
stabilization as the preferred method for cervical spine protection during airway
management. Nasotracheal intubation is contraindicated in apneic patients, supraglottic
airways do not definitively secure the airway, and cricothyrotomy is a rescue technique not
first-line.
4. A patient with STEMI on the 12-lead ECG is 45 minutes from the nearest
PCI-capable hospital. According to Clallam County EMS protocols, which action is
most appropriate?
A. Administer fibrinolytic therapy if symptom onset is within 12 hours and no
contraindications.
B. Transport directly to the PCI center with prehospital activation, regardless of transport
time.
C. Divert to the closest non-PCI hospital for stabilization and subsequent transfer.
D. Administer aspirin and nitroglycerin, then reassess for transport decision.
Answer: B. Transport directly to the PCI center with prehospital activation,
regardless of transport time.
Rationale: Clallam County protocols prioritize direct transport to a PCI-capable facility
when prehospital activation is possible, even with longer transport times, as primary PCI is
superior to fibrinolysis when achievable within 120 minutes. Fibrinolysis is not
recommended when timely PCI is available, and diversion to a non-PCI hospital delays
definitive care.
Page 2 of 75
,5. A patient with a traumatic amputation of the left arm is bleeding profusely despite
direct pressure. Which Clallam County EMS protocol intervention is indicated next?
A. Apply a tourniquet proximal to the amputation site.
B. Elevate the extremity and apply a pressure dressing.
C. Administer tranexamic acid 1 g IV over 10 minutes.
D. Pack the wound with hemostatic gauze and apply direct pressure.
Answer: A. Apply a tourniquet proximal to the amputation site.
Rationale: Clallam County protocols recommend tourniquet application for
life-threatening extremity hemorrhage not controlled by direct pressure. Elevation and
pressure dressings are ineffective for arterial bleeding, tranexamic acid is adjunctive but
not immediate hemorrhage control, and hemostatic gauze is used for junctional wounds.
6. A patient with severe sepsis presents with hypotension and tachycardia. According
to Clallam County EMS protocols, which fluid resuscitation strategy is recommended?
A. Administer 500 mL boluses of 0.9% NaCl, reassessing after each bolus.
B. Administer 2 L of lactated Ringer's solution rapidly over 15 minutes.
C. Administer 1 L of 0.9% NaCl over 30 minutes, then start norepinephrine.
D. Administer 250 mL boluses of 0.9% NaCl, reassessing after each bolus.
Answer: A. Administer 500 mL boluses of 0.9% NaCl, reassessing after each bolus.
Rationale: Clallam County protocols recommend cautious fluid resuscitation with 500 mL
boluses of isotonic crystalloid in sepsis, with frequent reassessment to avoid fluid overload.
Rapid 2 L boluses are not advised in the prehospital setting, and vasopressors are initiated
only after adequate fluid resuscitation.
Page 3 of 75
, 7. A patient with a suspected tension pneumothorax presents with severe dyspnea,
unilateral absent breath sounds, and hypotension. Which Clallam County EMS
protocol intervention is indicated?
A. Needle decompression at the second intercostal space, midclavicular line.
B. Needle decompression at the fifth intercostal space, anterior axillary line.
C. Application of a three-sided occlusive dressing.
D. Positive pressure ventilation with a bag-valve-mask.
Answer: A. Needle decompression at the second intercostal space, midclavicular line.
Rationale: Clallam County protocols specify needle decompression at the second
intercostal space, midclavicular line, for tension pneumothorax. The fifth intercostal space
is an alternative but not the primary site in this protocol, occlusive dressings are for open
pneumothorax, and positive pressure ventilation can worsen tension pneumothorax.
8. Which of the following best describes the Clallam County EMS protocol for
termination of resuscitation (TOR) in out-of-hospital cardiac arrest?
A. TOR may be considered after 20 minutes of ACLS without ROSC, asystole
throughout, and no reversible causes.
B. TOR is never permitted; all patients must be transported to the hospital.
C. TOR requires online medical control approval after 30 minutes of ACLS.
D. TOR may be considered after 10 minutes of ACLS if the patient remains in asystole.
Answer: A. TOR may be considered after 20 minutes of ACLS without ROSC,
asystole throughout, and no reversible causes.
Rationale: Clallam County protocols allow TOR after 20 minutes of ACLS without ROSC,
persistent asystole, and exclusion of reversible causes, consistent with national guidelines.
TOR is not prohibited, online approval is not mandated, and 10 minutes is insufficient.
Page 4 of 75
