Douglas County EMS Protocols Exam
With Practice Questions And Correct
Answers (Verified A
1. A patient with severe asthma exacerbation and impending respiratory failure is
being managed per Douglas County EMS protocol. After continuous albuterol and
ipratropium, the patient remains in severe distress with silent chest. Which
intervention is most appropriate next according to protocol?
A. Administer intramuscular epinephrine 0.3 mg (1:1000).
B. Administer intravenous magnesium sulfate 2 g over 10 minutes.
C. Initiate CPAP with 10 cmH2O and continue bronchodilators.
D. Administer intramuscular ketamine 2 mg/kg for sedation.
Answer: B. Administer intravenous magnesium sulfate 2 g over 10 minutes.
Rationale: Douglas County EMS protocol for severe asthma with impending failure
includes IV magnesium sulfate 2 g as an adjunct after initial bronchodilators. IM
epinephrine is not standard for asthma in adults; CPAP may be considered but is not the
primary next step; ketamine is not indicated for asthma per protocol.
2. A patient with suspected opioid overdose presents with respiratory depression. Per
Douglas County EMS protocol, which medication and route is first-line for
opioid-induced respiratory depression?
A. Naloxone 2 mg intranasal
B. Naloxone 0.4 mg intramuscular
C. Naloxone 0.4 mg intravenous
D. Naloxone 0.1 mg intranasal
Answer: A. Naloxone 2 mg intranasal
Rationale: Douglas County EMS protocol prioritizes intranasal naloxone 2 mg for
suspected opioid overdose due to ease of administration and rapid onset. IV/IM routes are
alternatives but not first-line in the protocol; 0.1 mg intranasal is subtherapeutic.
Page 1 of 78
,3. A patient with a suspected cervical spine injury requires airway management.
According to Douglas County EMS protocol, which technique is preferred for
endotracheal intubation in this scenario?
A. Direct laryngoscopy with manual in-line stabilization.
B. Video laryngoscopy with manual in-line stabilization.
C. Blind nasotracheal intubation.
D. Retrograde intubation.
Answer: B. Video laryngoscopy with manual in-line stabilization.
Rationale: The protocol recommends video laryngoscopy with manual in-line stabilization
for suspected cervical spine injury, as it improves glottic visualization while minimizing
cervical movement. Direct laryngoscopy is acceptable but video is preferred; blind
nasotracheal and retrograde are not first-line.
4. A patient with ST-elevation myocardial infarction (STEMI) is being transported.
Per Douglas County EMS protocol, which destination should be selected if the patient
is within 30 minutes of a PCI-capable hospital?
A. Nearest hospital regardless of PCI capability.
B. Nearest PCI-capable hospital.
C. Nearest hospital with a helipad for air transport.
D. Nearest critical access hospital for stabilization.
Answer: B. Nearest PCI-capable hospital.
Rationale: Douglas County EMS protocol directs transport to the nearest PCI-capable
hospital if within 30 minutes transport time, to minimize reperfusion delay. Non-PCI
hospitals are bypassed unless transport time exceeds 30 minutes or other extenuating
factors apply.
Page 2 of 78
,5. A patient with severe traumatic brain injury (TBI) has a Glasgow Coma Scale
(GCS) of 6. According to Douglas County EMS protocol, which intervention is
contraindicated in the prehospital management of this patient?
A. Hyperventilation to a target end-tidal CO2 of 25 mmHg.
B. Maintaining systolic blood pressure > 90 mmHg.
C. Elevating the head of the stretcher 30 degrees.
D. Administering 3% hypertonic saline if signs of herniation.
Answer: A. Hyperventilation to a target end-tidal CO2 of 25 mmHg.
Rationale: Prophylactic hyperventilation to an EtCO2 of 25 mmHg is contraindicated in
TBI per protocol due to risk of cerebral ischemia; it is reserved for acute herniation. The
other options are recommended: maintain SBP, head elevation, and hypertonic saline for
herniation.
6. A patient with suspected sepsis meets Douglas County EMS sepsis alert criteria.
Which of the following is NOT a required component of the prehospital sepsis
protocol?
A. Obtaining a lactate level.
B. Administering a 30 mL/kg crystalloid bolus.
C. Applying supplemental oxygen to maintain SpO2 94%.
D. Administering broad-spectrum antibiotics.
Answer: D. Administering broad-spectrum antibiotics.
Rationale: Prehospital administration of broad-spectrum antibiotics is not part of Douglas
County EMS sepsis protocol. Lactate measurement, fluid bolus, and oxygen are included;
antibiotics are initiated at the hospital.
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, 7. A patient with an acute ischemic stroke has a last known well time of 4.5 hours ago.
Per Douglas County EMS protocol, which action is most appropriate?
A. Transport to the nearest hospital regardless of stroke center status.
B. Transport to a primary stroke center within 30 minutes.
C. Administer aspirin 325 mg orally.
D. Administer tissue plasminogen activator (tPA) in the field.
Answer: B. Transport to a primary stroke center within 30 minutes.
Rationale: Douglas County EMS protocol directs transport to a primary stroke center if
within 30 minutes for potential thrombolysis. Aspirin is not administered prehospital due to
hemorrhagic stroke risk; tPA is not given in the field; nearest hospital may lack stroke
capabilities.
8. A patient with anaphylaxis has received IM epinephrine and is still hypotensive.
According to Douglas County EMS protocol, which intervention is next?
A. Administer a 1 L normal saline bolus.
B. Administer IV epinephrine infusion at 1 mcg/min.
C. Administer diphenhydramine 50 mg IV.
D. Administer methylprednisolone 125 mg IV.
Answer: B. Administer IV epinephrine infusion at 1 mcg/min.
Rationale: For refractory anaphylaxis after IM epinephrine, the protocol recommends an
IV epinephrine infusion. Fluid bolus and adjuncts like antihistamines and steroids are
secondary; IV epinephrine is the priority for persistent hypotension.
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With Practice Questions And Correct
Answers (Verified A
1. A patient with severe asthma exacerbation and impending respiratory failure is
being managed per Douglas County EMS protocol. After continuous albuterol and
ipratropium, the patient remains in severe distress with silent chest. Which
intervention is most appropriate next according to protocol?
A. Administer intramuscular epinephrine 0.3 mg (1:1000).
B. Administer intravenous magnesium sulfate 2 g over 10 minutes.
C. Initiate CPAP with 10 cmH2O and continue bronchodilators.
D. Administer intramuscular ketamine 2 mg/kg for sedation.
Answer: B. Administer intravenous magnesium sulfate 2 g over 10 minutes.
Rationale: Douglas County EMS protocol for severe asthma with impending failure
includes IV magnesium sulfate 2 g as an adjunct after initial bronchodilators. IM
epinephrine is not standard for asthma in adults; CPAP may be considered but is not the
primary next step; ketamine is not indicated for asthma per protocol.
2. A patient with suspected opioid overdose presents with respiratory depression. Per
Douglas County EMS protocol, which medication and route is first-line for
opioid-induced respiratory depression?
A. Naloxone 2 mg intranasal
B. Naloxone 0.4 mg intramuscular
C. Naloxone 0.4 mg intravenous
D. Naloxone 0.1 mg intranasal
Answer: A. Naloxone 2 mg intranasal
Rationale: Douglas County EMS protocol prioritizes intranasal naloxone 2 mg for
suspected opioid overdose due to ease of administration and rapid onset. IV/IM routes are
alternatives but not first-line in the protocol; 0.1 mg intranasal is subtherapeutic.
Page 1 of 78
,3. A patient with a suspected cervical spine injury requires airway management.
According to Douglas County EMS protocol, which technique is preferred for
endotracheal intubation in this scenario?
A. Direct laryngoscopy with manual in-line stabilization.
B. Video laryngoscopy with manual in-line stabilization.
C. Blind nasotracheal intubation.
D. Retrograde intubation.
Answer: B. Video laryngoscopy with manual in-line stabilization.
Rationale: The protocol recommends video laryngoscopy with manual in-line stabilization
for suspected cervical spine injury, as it improves glottic visualization while minimizing
cervical movement. Direct laryngoscopy is acceptable but video is preferred; blind
nasotracheal and retrograde are not first-line.
4. A patient with ST-elevation myocardial infarction (STEMI) is being transported.
Per Douglas County EMS protocol, which destination should be selected if the patient
is within 30 minutes of a PCI-capable hospital?
A. Nearest hospital regardless of PCI capability.
B. Nearest PCI-capable hospital.
C. Nearest hospital with a helipad for air transport.
D. Nearest critical access hospital for stabilization.
Answer: B. Nearest PCI-capable hospital.
Rationale: Douglas County EMS protocol directs transport to the nearest PCI-capable
hospital if within 30 minutes transport time, to minimize reperfusion delay. Non-PCI
hospitals are bypassed unless transport time exceeds 30 minutes or other extenuating
factors apply.
Page 2 of 78
,5. A patient with severe traumatic brain injury (TBI) has a Glasgow Coma Scale
(GCS) of 6. According to Douglas County EMS protocol, which intervention is
contraindicated in the prehospital management of this patient?
A. Hyperventilation to a target end-tidal CO2 of 25 mmHg.
B. Maintaining systolic blood pressure > 90 mmHg.
C. Elevating the head of the stretcher 30 degrees.
D. Administering 3% hypertonic saline if signs of herniation.
Answer: A. Hyperventilation to a target end-tidal CO2 of 25 mmHg.
Rationale: Prophylactic hyperventilation to an EtCO2 of 25 mmHg is contraindicated in
TBI per protocol due to risk of cerebral ischemia; it is reserved for acute herniation. The
other options are recommended: maintain SBP, head elevation, and hypertonic saline for
herniation.
6. A patient with suspected sepsis meets Douglas County EMS sepsis alert criteria.
Which of the following is NOT a required component of the prehospital sepsis
protocol?
A. Obtaining a lactate level.
B. Administering a 30 mL/kg crystalloid bolus.
C. Applying supplemental oxygen to maintain SpO2 94%.
D. Administering broad-spectrum antibiotics.
Answer: D. Administering broad-spectrum antibiotics.
Rationale: Prehospital administration of broad-spectrum antibiotics is not part of Douglas
County EMS sepsis protocol. Lactate measurement, fluid bolus, and oxygen are included;
antibiotics are initiated at the hospital.
Page 3 of 78
, 7. A patient with an acute ischemic stroke has a last known well time of 4.5 hours ago.
Per Douglas County EMS protocol, which action is most appropriate?
A. Transport to the nearest hospital regardless of stroke center status.
B. Transport to a primary stroke center within 30 minutes.
C. Administer aspirin 325 mg orally.
D. Administer tissue plasminogen activator (tPA) in the field.
Answer: B. Transport to a primary stroke center within 30 minutes.
Rationale: Douglas County EMS protocol directs transport to a primary stroke center if
within 30 minutes for potential thrombolysis. Aspirin is not administered prehospital due to
hemorrhagic stroke risk; tPA is not given in the field; nearest hospital may lack stroke
capabilities.
8. A patient with anaphylaxis has received IM epinephrine and is still hypotensive.
According to Douglas County EMS protocol, which intervention is next?
A. Administer a 1 L normal saline bolus.
B. Administer IV epinephrine infusion at 1 mcg/min.
C. Administer diphenhydramine 50 mg IV.
D. Administer methylprednisolone 125 mg IV.
Answer: B. Administer IV epinephrine infusion at 1 mcg/min.
Rationale: For refractory anaphylaxis after IM epinephrine, the protocol recommends an
IV epinephrine infusion. Fluid bolus and adjuncts like antihistamines and steroids are
secondary; IV epinephrine is the priority for persistent hypotension.
Page 4 of 78
