Clark County EMS Protocols Exam With
Practice Questions And Correct Answers
(Verified Ans
1. Under Clark County EMS protocols, which intervention is prioritized for a patient
with suspected opioid-induced respiratory depression who has a palpable radial pulse
but agonal respirations?
A. Immediate naloxone 2 mg intranasal without assisted ventilation
B. Assisted ventilation with BVM followed by naloxone titration to adequate respiration
C. CPR initiation due to agonal respirations
D. Insertion of supraglottic airway prior to any pharmacologic reversal
Answer: B. Assisted ventilation with BVM followed by naloxone titration to adequate
respiration
Rationale: Protocols emphasize airway and ventilation first; naloxone is titrated to restore
spontaneous respirations, not full arousal. Immediate naloxone without ventilation risks
hypoxia and withdrawal. CPR is not indicated with a palpable pulse. SGA is not first-line
before basic ventilation.
2. A conscious patient with severe asthma exacerbation has received three
albuterol/ipratropium nebulizers and IM epinephrine per protocol. Which additional
Clark County protocol intervention is now indicated?
A. Magnesium sulfate 2 g IV over 20 minutes
B. High-dose corticosteroid IV push
C. Heliox administration via non-rebreather
D. CPAP initiation at 5 cm H2O
Answer: A. Magnesium sulfate 2 g IV over 20 minutes
Rationale: Clark County protocols include IV magnesium sulfate for severe asthma
refractory to initial bronchodilators and epinephrine. Corticosteroids are typically given
early but not as a rescue after multiple therapies. Heliox is not standard in this protocol.
CPAP may be considered but magnesium is the specific next step.
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,3. In a patient with suspected ST-elevation myocardial infarction (STEMI) and
ongoing chest pain, which Clark County EMS action most directly reduces
door-to-balloon time at the receiving PCI center?
A. Administration of aspirin 324 mg chewed
B. Obtaining a 12-lead ECG within 10 minutes of arrival and transmitting to the PCI
center
C. Establishing two large-bore IVs and administering nitroglycerin
D. Applying supplemental oxygen to maintain SpO2 >94%
Answer: B. Obtaining a 12-lead ECG within 10 minutes of arrival and transmitting to
the PCI center
Rationale: Early ECG acquisition and transmission activate the cath lab before arrival,
directly reducing door-to-balloon time. Aspirin, IVs, and oxygen are important but do not
independently expedite reperfusion. Transmission is the key system-based intervention.
4. Which finding in a patient with a suspected cervical spine injury would most
influence a Clark County paramedic to forego full spinal immobilization per current
protocol?
A. GCS of 15 with no midline tenderness and no distracting injury
B. Patient is under the influence of alcohol
C. Patient reports transient paresthesia that resolved
D. Mechanism is a high-speed MVC with rollover
Answer: A. GCS of 15 with no midline tenderness and no distracting injury
Rationale: Current protocols incorporate the NEXUS criteria; a patient with GCS 15, no
midline tenderness, no neurologic deficit, and no distracting injury can be cleared
clinically. Alcohol intoxication, transient symptoms, and high-risk mechanism would
mandate immobilization.
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,5. A patient with severe sepsis has a mean arterial pressure (MAP) of 58 mmHg
despite 30 mL/kg crystalloid bolus. According to Clark County EMS protocols, which
vasopressor is preferred if fluid resuscitation is inadequate?
A. Dopamine infusion at 5 mcg/kg/min
B. Norepinephrine infusion titrated to MAP 65 mmHg
C. Phenylephrine bolus 100 mcg
D. Vasopressin infusion at 0.04 units/min
Answer: B. Norepinephrine infusion titrated to MAP 65 mmHg
Rationale: Norepinephrine is the first-line vasopressor for septic shock per Surviving
Sepsis Campaign and Clark County protocols. Dopamine is no longer preferred due to
arrhythmia risk. Phenylephrine and vasopressin are second-line or adjunctive.
6. During a mass casualty incident, which triage category under the Clark County
EMS system is assigned to a patient with a respiratory rate of 8 after airway
repositioning?
A. Immediate (Red)
B. Delayed (Yellow)
C. Minor (Green)
D. Expectant (Black)
Answer: A. Immediate (Red)
Rationale: In START triage, a patient with respiratory rate <10 after airway repositioning
is tagged Immediate (Red) because they require immediate airway intervention. Expectant
(Black) is reserved for those with no respirations after repositioning. Delayed and Minor
do not fit this physiologic derangement.
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, 7. Which statement best reflects the Clark County EMS protocol regarding
prehospital termination of resuscitation (TOR) in out-of-hospital cardiac arrest?
A. TOR is permissible after 20 minutes of ACLS with asystole and no reversible causes.
B. TOR requires online medical control approval in all cases.
C. TOR is contraindicated if the arrest was witnessed by EMS.
D. TOR may be considered after 30 minutes of ACLS with no ROSC and no shockable
rhythm.
Answer: D. TOR may be considered after 30 minutes of ACLS with no ROSC and no
shockable rhythm.
Rationale: Clark County protocols align with national guidelines allowing TOR after 30
minutes of ACLS without ROSC, no shockable rhythm, and no reversible causes. Witnessed
arrest by EMS may still warrant transport. Online medical control may be required but not
universally. Asystole alone at 20 minutes is insufficient.
8. A patient with suspected tension pneumothorax is being managed by a Clark
County paramedic. Which intervention is indicated before needle decompression
according to protocol?
A. Obtain chest X-ray confirmation
B. Administer high-flow oxygen and assess for tracheal deviation
C. Perform immediate needle decompression without further assessment
D. Initiate CPAP to improve oxygenation
Answer: B. Administer high-flow oxygen and assess for tracheal deviation
Rationale: Protocols require oxygen and rapid clinical assessment (e.g., tracheal deviation,
unilateral breath sounds) to support the diagnosis before needle decompression. Chest
X-ray is not available prehospital. CPAP is contraindicated in tension pneumothorax.
Immediate decompression without assessment is not protocol-compliant.
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Practice Questions And Correct Answers
(Verified Ans
1. Under Clark County EMS protocols, which intervention is prioritized for a patient
with suspected opioid-induced respiratory depression who has a palpable radial pulse
but agonal respirations?
A. Immediate naloxone 2 mg intranasal without assisted ventilation
B. Assisted ventilation with BVM followed by naloxone titration to adequate respiration
C. CPR initiation due to agonal respirations
D. Insertion of supraglottic airway prior to any pharmacologic reversal
Answer: B. Assisted ventilation with BVM followed by naloxone titration to adequate
respiration
Rationale: Protocols emphasize airway and ventilation first; naloxone is titrated to restore
spontaneous respirations, not full arousal. Immediate naloxone without ventilation risks
hypoxia and withdrawal. CPR is not indicated with a palpable pulse. SGA is not first-line
before basic ventilation.
2. A conscious patient with severe asthma exacerbation has received three
albuterol/ipratropium nebulizers and IM epinephrine per protocol. Which additional
Clark County protocol intervention is now indicated?
A. Magnesium sulfate 2 g IV over 20 minutes
B. High-dose corticosteroid IV push
C. Heliox administration via non-rebreather
D. CPAP initiation at 5 cm H2O
Answer: A. Magnesium sulfate 2 g IV over 20 minutes
Rationale: Clark County protocols include IV magnesium sulfate for severe asthma
refractory to initial bronchodilators and epinephrine. Corticosteroids are typically given
early but not as a rescue after multiple therapies. Heliox is not standard in this protocol.
CPAP may be considered but magnesium is the specific next step.
Page 1 of 76
,3. In a patient with suspected ST-elevation myocardial infarction (STEMI) and
ongoing chest pain, which Clark County EMS action most directly reduces
door-to-balloon time at the receiving PCI center?
A. Administration of aspirin 324 mg chewed
B. Obtaining a 12-lead ECG within 10 minutes of arrival and transmitting to the PCI
center
C. Establishing two large-bore IVs and administering nitroglycerin
D. Applying supplemental oxygen to maintain SpO2 >94%
Answer: B. Obtaining a 12-lead ECG within 10 minutes of arrival and transmitting to
the PCI center
Rationale: Early ECG acquisition and transmission activate the cath lab before arrival,
directly reducing door-to-balloon time. Aspirin, IVs, and oxygen are important but do not
independently expedite reperfusion. Transmission is the key system-based intervention.
4. Which finding in a patient with a suspected cervical spine injury would most
influence a Clark County paramedic to forego full spinal immobilization per current
protocol?
A. GCS of 15 with no midline tenderness and no distracting injury
B. Patient is under the influence of alcohol
C. Patient reports transient paresthesia that resolved
D. Mechanism is a high-speed MVC with rollover
Answer: A. GCS of 15 with no midline tenderness and no distracting injury
Rationale: Current protocols incorporate the NEXUS criteria; a patient with GCS 15, no
midline tenderness, no neurologic deficit, and no distracting injury can be cleared
clinically. Alcohol intoxication, transient symptoms, and high-risk mechanism would
mandate immobilization.
Page 2 of 76
,5. A patient with severe sepsis has a mean arterial pressure (MAP) of 58 mmHg
despite 30 mL/kg crystalloid bolus. According to Clark County EMS protocols, which
vasopressor is preferred if fluid resuscitation is inadequate?
A. Dopamine infusion at 5 mcg/kg/min
B. Norepinephrine infusion titrated to MAP 65 mmHg
C. Phenylephrine bolus 100 mcg
D. Vasopressin infusion at 0.04 units/min
Answer: B. Norepinephrine infusion titrated to MAP 65 mmHg
Rationale: Norepinephrine is the first-line vasopressor for septic shock per Surviving
Sepsis Campaign and Clark County protocols. Dopamine is no longer preferred due to
arrhythmia risk. Phenylephrine and vasopressin are second-line or adjunctive.
6. During a mass casualty incident, which triage category under the Clark County
EMS system is assigned to a patient with a respiratory rate of 8 after airway
repositioning?
A. Immediate (Red)
B. Delayed (Yellow)
C. Minor (Green)
D. Expectant (Black)
Answer: A. Immediate (Red)
Rationale: In START triage, a patient with respiratory rate <10 after airway repositioning
is tagged Immediate (Red) because they require immediate airway intervention. Expectant
(Black) is reserved for those with no respirations after repositioning. Delayed and Minor
do not fit this physiologic derangement.
Page 3 of 76
, 7. Which statement best reflects the Clark County EMS protocol regarding
prehospital termination of resuscitation (TOR) in out-of-hospital cardiac arrest?
A. TOR is permissible after 20 minutes of ACLS with asystole and no reversible causes.
B. TOR requires online medical control approval in all cases.
C. TOR is contraindicated if the arrest was witnessed by EMS.
D. TOR may be considered after 30 minutes of ACLS with no ROSC and no shockable
rhythm.
Answer: D. TOR may be considered after 30 minutes of ACLS with no ROSC and no
shockable rhythm.
Rationale: Clark County protocols align with national guidelines allowing TOR after 30
minutes of ACLS without ROSC, no shockable rhythm, and no reversible causes. Witnessed
arrest by EMS may still warrant transport. Online medical control may be required but not
universally. Asystole alone at 20 minutes is insufficient.
8. A patient with suspected tension pneumothorax is being managed by a Clark
County paramedic. Which intervention is indicated before needle decompression
according to protocol?
A. Obtain chest X-ray confirmation
B. Administer high-flow oxygen and assess for tracheal deviation
C. Perform immediate needle decompression without further assessment
D. Initiate CPAP to improve oxygenation
Answer: B. Administer high-flow oxygen and assess for tracheal deviation
Rationale: Protocols require oxygen and rapid clinical assessment (e.g., tracheal deviation,
unilateral breath sounds) to support the diagnosis before needle decompression. Chest
X-ray is not available prehospital. CPAP is contraindicated in tension pneumothorax.
Immediate decompression without assessment is not protocol-compliant.
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